Fujimoto Y, Obara T, Ito Y, Kodama T, Yashiro T, Yamashita T, Nozaki M, Suzuki K
Surgery. 1986 Dec;100(6):1098-107.
Aggressive radical resection was performed on 18 of 21 elderly patients with locally invasive-papillary carcinoma of the thyroid. Diagnostic studies, including computed tomographic and endoscopic examinations, were useful in allowing accurate determination of tumor extent. Radical resection usually consisted of total or subtotal thyroidectomy and neck dissection combined with excision of the affected organs, which in one case included a laryngotracheoesophagectomy (reconstruction of the digestive tract with a forearm free flap), a sleeve, or a window resection of the trachea in nine cases (immediate end-to-end anastomosis in all but one), a partial esophagectomy in two cases, and resection of the outer layer of the trachea or esophagus in six cases. After these operations, one patient died of rupture of the carotid artery, one died of cancer in 4 years, and one other died of unrelated disease. The other 15 patients are alive and well 1 to 5 years postoperatively, although additional exploration for nodal metastases was required in three patients. Aggressive resection therefore appears to be justified for control of locally advanced, differentiated carcinoma of the thyroid.
21例老年甲状腺局部浸润性乳头状癌患者中的18例接受了积极的根治性切除术。包括计算机断层扫描和内镜检查在内的诊断性研究，有助于准确确定肿瘤范围。根治性切除通常包括全甲状腺或次全甲状腺切除及颈部清扫，并联合切除受累器官，其中1例包括喉气管食管切除术（采用游离前臂皮瓣重建消化道），9例进行气管袖状或开窗切除术（除1例外在所有病例中均立即进行端端吻合），2例进行部分食管切除术，6例进行气管或食管外层切除术。这些手术后，1例患者死于颈动脉破裂，1例在4年后死于癌症，另1例死于无关疾病。其他15例患者术后1至5年存活且状况良好，不过有3例患者需要进一步探查有无淋巴结转移。因此，积极切除对于控制局部晚期分化型甲状腺癌似乎是合理的。
