Ko J Y, Sheen T S
Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei.
J Formos Med Assoc. 1998 Apr;97(4):289-91.
Invasion of the air passage, especially with intraluminal involvement of well-differentiated thyroid carcinoma, is rare. Establishing a patent airway before surgery is necessary, but difficult and risky. We report a case of thyroid cancer with intraluminal invasion of the trachea. A 62-year-old schizophrenic woman presented with blood-tinged sputum and dyspnea. She had undergone a thyroid lobectomy 8 years previously. Computed tomography and bronchoscopy showed a protruding mass in the upper trachea and limited movement of the bilateral vocal folds. Emergency tracheostomy was performed to relieve impending apnea. Fine-needle aspiration of the left protruding thyroid gland showed papillary carcinoma. Because the tumor diffusely infiltrated the thyroid gland and intermingled with fibrosis due to the previous thyroid operation, and because there was limited movement of bilateral vocal folds, the patient underwent total laryngectomy, total thyroidectomy, total parathyroidectomy, and tracheal resection. Neither radioactive iodine nor external irradiation were given because of anticipated poor compliance due to schizophrenia. The postoperative course was smooth and thyroid hormone and calcium were supplemented regularly. The patient has lived well and without local recurrence for more than 3 years since the operation. She can speak with an artificial larynx.
气道受侵，尤其是高分化甲状腺癌累及管腔者较为罕见。手术前建立通畅气道很必要，但困难且有风险。我们报告一例甲状腺癌气管腔内受侵的病例。一名62岁的精神分裂症女性患者出现痰中带血、呼吸困难症状8年前她曾接受过甲状腺叶切除术。计算机断层扫描和支气管镜检查显示气管上段有一突出肿物，双侧声带活动受限。紧急行气管切开术，以缓解即将发生的呼吸暂停。细针穿刺左叶突出的甲状腺组织显示为乳头状癌。由于肿瘤弥漫性浸润甲状腺，且因既往甲状腺手术存在纤维组织增生，还由于双侧声带活动受限，患者接受了全喉切除术、甲状腺全切除术、甲状旁腺全切除术及气管部分切除术，因预计精神分裂症患者依从性差，未给予放射性碘治疗和外照射治疗。术后恢复顺利，定期补充甲状腺激素和钙剂。术后3年多来，患者生活良好，无局部复发，可通过人工喉说话。
