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題名 | 侵犯上呼吸消化道之分化良好甲狀腺癌=Well Differentiated Thyroid Carcinoma with Upper Aerodigestive Tract Involvement |
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作者姓名(中文) | 吳鎮宇; 朱本元; 張學逸; | 書刊名 | 中華民國耳鼻喉科醫學雜誌 |
卷期 | 34:3 民88.05-06 |
頁次 | 頁188-194 |
分類號 | 416.8 |
關鍵詞 | 分化良好的甲狀腺癌; 上呼吸消化道侵犯; Well-differentiated thyroid carcinoma; Upper aerodigestive tract involvement; |
語文 | 中文(Chinese) |
中文摘要 | 背景:甲狀腺癌大部分為分化良好、性長緩慢、預後頗佳的惡性腫瘤。但是當分化 良好的甲狀腺癌局部侵犯到上呼吸消化道時,其處理原則及預後是否有所不同,本研究將進 行討論。 方法:回溯性的分析自1981至1996年間,在本院接受手術之24例分化良好的甲狀腺癌 合併上呼吸消化道侵犯的病人。手術的方式依腫瘤侵犯程度分為:腫瘤全切除術(complete resection),腫瘤削去術(shave-off),腫瘤部分切除術(partial resection),術後追蹤的 時間從4個月到13年不等,並以Kaplan-Meier方法依月數求出累計存活曲線加以比較。 結果:24例病患中,男性7例,女性17例,平均年齡57歲,其中乳頭狀癌有18例,濾 泡狀癌有6例。侵犯的位置以氣管最多,佔14例,其次分別為喉部、食道及咽部。手術的方 式包括腫瘤全切除術15例,腫瘤削去術4例,腫瘤部分切除術5例。有3例病人因手術併發 症於術後死亡,其餘21例均接受術後放射I-131治療。依Kaplan-Meier的方法計算,5年 總存活率為72.1%,5年疾病存活率為76.6%。首次發作的11例中有8例存活,5年存活率為 90.9%;復發的13例中也有8例存活,5年存活率為63.5%,兩組比較,P值為0.0867,沒有 明顯的統計學上的差異。若依年齡來看,小於60歲組5年存活率為91.7%,大於60歲組5 年存活率為62.5%,兩組比較,P值為0.1971,也沒有明顯的統計學上的差異。若依手術方 法來看,行徹底切除的病人,5年存活率為84.9%,行腫瘤削去術的5年存活率為66.7%。而 行部分切除術的5年存活率為50%。 結論:侵犯上呼吸消化道的甲狀腺癌通常容易局部復發且預後較差,必須積極治療。手術 原則為徹底切除腫瘤,並儘可能保存上呼吸消化道功能,安全邊緣可以較一般上皮癌小。對 於僅有較表淺管壁侵犯的病例,腫瘤削去術既可保留器官功能,又能達到不錯的局部控制率; 但是當腫瘤範圍太廣泛或是有管腔內侵犯的情形,則需施行腫瘤全切除術才能達成滿意的局 部控制率及存活率。而腫瘤部份切除術,無論是在腫瘤局部控制率或是存活率上均不能令人 滿意。 |
英文摘要 | Background: Most thyroid carcinomas are well-differentiated, slow-glowing tumors with a good prognosis. However, when the upper aerodigestive tract is involved, the surgeon encounters a more difficult situation. Methods: From 1981 to 1996, Twenty-four patients with thyroid carcinoma with upper aerodigestive tract invasion visited our hospital. Three types of surgery were used according to the extent of tumor invasion: tumor resection with a safe margin, tumor shave-off without a safe margin and partial resection with the gross tumor left behind. Most of the patients received at least one course of post-operative I□ ablation therapy. Five year survival rate was calculated with the statistic method of Kaplan-Meier. Results: Among these 24 patients, there were 7 men and 17 women with an average age of 57 years. The most common sites of tumor invasion were the trachea, larynx, esophagus and pharynx. The surgeries performed included 15 complete tumor resections, 4 tumor shave-offs and 5 partial tumor resections. The over-all five year survival rate was 72.1%. The five year over-all survival rate in the group under the age of sixty was 91.7%, better than that of the group over sixty years old. The five year over-all survival rate of the complete tumor resection group was 84.9%, corresponding to 66.7% in the shave-off group and 50% in the partial tumor resection group. But the comparison is not very reasonable because of the small case numbers of the latter two groups. Conclusions: When thyroid carcinoma involves the upper aerodigestive tract, higher local recurrence rate is expected. The overall survival rate is poor. Therefore, an aggressive approach is required when dealing with these cases. The overall surgical principles are radical tumor resection with as much functional preservation as possible. The safe margin of resection of a well-differentiated thyroid carcinoma can be narrower than that of a squamous cell carcinoma. When there is minimal tumor invasion of the neighboring aerodigestive tract wall, tumor shave-off procedures are usually enough for an acceptable local control rate, but when the tumor has become widespread or when there is intraluminal invasion, only a radical tumor excision can promise an acceptable local control rate. Partial resection of the tumor is not recommended. |
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