Moyer Kelly F, Marcadis Andrea R, Shaha Ashok R
Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Surgery, Head and Neck Service, Yale University, New Haven, Connecticut, USA.
Curr Opin Otolaryngol Head Neck Surg. 2020 Apr;28(2):74-78. doi: 10.1097/MOO.0000000000000619.
Anaplastic thyroid cancer (ATC) is a rare but aggressive form of thyroid cancer that is associated with significant morbidity and mortality. Because ATC is locally invasive, airway management is a critical component of treating these patients. Timely decisions regarding airway interventions can contribute to symptom relief and supportive care for patients. Over the last decade, there has been a paradigm shift in our recommendations for airway management. The purpose of this review is to summarize airway management, symptom relief and best supportive care for patients with ATC.
More recent literature discusses the morbidities associated with tracheostomy and instead focuses on the benefits of supportive care and surgical resection. The multidisciplinary treating team should initiate early discussions for airway management, end-of-life care and palliative goals for patients with ATC. Tracheostomy should be offered to patients with careful thought and preoperative planning.
Our goal in symptom relief and airway management is to improve the quality of life of patients with ATC and avoid the unnecessary morbidity of tracheostomy until clinically indicated.
间变性甲状腺癌（ATC）是一种罕见但侵袭性强的甲状腺癌，与显著的发病率和死亡率相关。由于ATC具有局部侵袭性，气道管理是治疗这些患者的关键组成部分。关于气道干预的及时决策有助于为患者缓解症状并提供支持性护理。在过去十年中，我们对气道管理的建议发生了范式转变。本综述的目的是总结ATC患者的气道管理、症状缓解和最佳支持性护理。
最近的文献讨论了气管切开术相关的并发症，转而关注支持性护理和手术切除的益处。多学科治疗团队应为ATC患者尽早开展关于气道管理、临终护理和姑息治疗目标的讨论。应在经过深思熟虑和术前规划后为患者提供气管切开术。
我们在症状缓解和气道管理方面的目标是提高ATC患者的生活质量，并在临床指征出现之前避免气管切开术带来的不必要并发症。
