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T4a期甲状腺癌外科治疗的临床经验报告OACSTPCD

Clinical experience in surgical treatment of T4a thyroid cancer

中文摘要英文摘要

目的 分析T4a期甲状腺癌的临床特点及外科治疗策略.方法 回顾性纳入2004年1月至2021年5月间在四川省肿瘤医院头颈外科住院手术的甲状腺恶性肿瘤患者,共计纳入T4a的甲状腺癌病例303例,分析患者的病理分型、受侵器官、手术方式、生存时间等.分析患者的总生存率,使用Kaplan Meier法分析患者术后生存曲线.结果 在入组的303例患者中,共计53例患者失访,1年总生存率为98.4%(246/250),3年总生存率为97.0%(224/231),5年总生存率为90.2%(92/102).其中喉返神经单独受侵94例,失访13例,1年总生存率为100%(81/81),3年总生存率为98.7%(77/78),5年总生存率为97.4%(38/39).喉返神经合并气管/喉/食道受侵151例,失访31例,1年总生存率为96.7%(116/120),3年总生存率为95.3%(101/106),5年总生存率为82.2%(37/45).在生存曲线分析中,喉返神经单独受侵组较喉返神经合并气管、喉或食道等器官受侵组在总生存时间上存在优势.结论 T4a期甲状腺癌如果有手术机会,应该首选手术切除,通过合理的手术策略,根治性手术的同时重视重要组织器官的一期修复重建,患者可获得较好的生活质量和预后.

Objective To analyze the clinical features and surgical treatment strategies of T4a thyroid cancer.Methods We retrospectively analyzed patients with thyroid cancer treated in the Department of Head and Neck Surgery of Sichuan Cancer Hospital from January 2004 to May 2021.A total of 303 cases were included and statistically analyzed for pathological type,invaded organs,surgical approach,survival time,and overall survival rate.The postoperative survival curves of the patients were analyzed using the Kaplan Meier method.Results Of the 303 patients enrolled,53 patients were lost to follow-up,and the 1-year,3-year and 5-year overall survival rates were 98.4%(246/250),97.0%(224/231)and 90.2%(92/102),respectively.Of the 94 patients with recurrent laryngeal nerve invasion only,13 were lost to follow-up,and the 1-year,3-year and 5-year overall survival rates were 100%(81/81),98.7%(77/78)and 97.4%(38/39),respectively.There were 151 patients with invasion of recurrent laryngeal nerve and tracheal/laryngeal/esophageal nerve,31 of them were lost to follow-up,and the 1-year,3-year and 5-year overall survival rates were 96.7%(116/120),95.3%(101/106)and 82.2%(37/45),respectively.According to the survival curve analysis,the group with recurrent laryngeal nerve invasion only had an advantage in overall survival time over the group with recurrent laryngeal nerve and tracheal/laryngeal/esophageal invasion.Conclusion Surgical resection is supposed to be preferred for T4a thyroid cancer if there is a chance of surgery.A reasonable surgical strategy,radical surgery while preserving the vital tissues and organs,and one-stage repair and reconstruction can bring patients a better quality of life and prognosis.

王朝晖;陈义波;孙一心;伏桂明;王佳慧;陈锦;李春华

四川省肿瘤临床医学研究中心,四川省肿瘤医院研究所,四川省癌症防治中心,电子科技大学附属肿瘤医院,甲状腺-耳鼻咽喉头颈外科,四川成都 610041||电子科技大学医学院,四川成都 610054四川省肿瘤临床医学研究中心,四川省肿瘤医院研究所,四川省癌症防治中心,电子科技大学附属肿瘤医院,甲状腺-耳鼻咽喉头颈外科,四川成都 610041

临床医学

甲状腺癌局部晚期甲状腺癌外科治疗喉返神经修复重建

thyroid cancerlocal advanced thyroid cancersurgery treatmentrecurrent laryngeal nerverepair and reconstruction

《西安交通大学学报(医学版)》 2024 (001)

62-68 / 7

四川省干部保健科研课题(编号川干研2020-801)Supported by Sichuan Provincial Cadre Health Research Project(Sichuan Ganyan 2020-801)

10.7652/jdyxb202401011

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