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目的:探讨累及喉-气管的甲状腺乳头状癌切除术后喉-气管结构和功能保存、缺损的处理方法。方法:回顾我科2007-2014年13例甲状腺乳头状癌累及喉气管术中喉气管结构保存和缺损处理的治疗效果,其中不包含全喉切除病例。男3例,女10例;年龄46~67岁,中位年龄53岁。初次手术累及喉气管5例,局部复发累及喉气管8例。术前通过纤维喉镜及CT明确病变范围。首次手术患者行甲状腺全切及累及喉气管切除加择区颈淋巴清扫术。复发病例作复发灶及累及喉气管部分切除加择区颈淋巴清扫术。缺损的处理采用3种方式。带蒂胸锁乳突肌锁骨骨膜皮瓣、颈阔肌带蒂皮瓣或保留缺损段喉气管结构喉气管造瘘、待二期修复的处理方法。术后随访半年到3年。结果:13例患者中10例拔管,3例终身带管(其中2例二期皮瓣转移缩小造瘘口)。结论:选择适当病例,选用皮瓣转移或喉气管造瘘二期修复,都可以保留部分喉气管结构和功能,提高患者生存质量。
Objective: To explore the treatment of laryngeal-tracheal structure and function preservation and defect after laryngeal-tracheal thyroid papillary carcinoma resection. Methods: A retrospective review of our department from 2007 to 2014 13 cases of thyroid papillary carcinoma involving laryngotracheal tube laryngeal tracheal structure preservation and defect treatment, which does not include cases of total laryngectomy. 3 males and 10 females; aged 46 to 67 years old, the median age of 53 years. The first operation involving laryngotracheal tube in 5 cases, local recurrence involving the larynx trachea in 8 cases. Preoperative fibrolaryngoscope and CT clear lesions. Total thyroidectomy and throat tracheostomy plus neck dissection were performed in the first surgery. Recurrent cases of recurrent larynx and involving the laryngotracheal resection plus choice of neck lymph node dissection. Defect treatment using three ways. Pedunculated sternocleidomastoid clavicle periosteal flap, platysma flap pedicle flap or laryngeal tracheal fistula to maintain the defect section laryngotracheal tube, to be treated by the second phase of repair. Follow-up six months to three years. Results: Of the 13 patients, 10 were extubated and 3 had life-long laparotomy (2 of them had stage 2 flaps metastatic and contracted stoma). Conclusion: Choosing the appropriate cases, choosing flap transfer or laryngotracheal tube fistulation in the second phase of repair, can retain some of the laryngotracheal tube structure and function, and improve the quality of life of patients.