论文部分内容阅读
目的评价经支气管镜介入治疗甲状腺癌侵犯气管的临床效果、并发症及预后。方法回顾性分析长海医院呼吸内科自2006年1月至2015年9月收治的43例甲状腺癌侵犯气管患者的临床资料。根据甲状腺癌侵犯气管的类型、狭窄程度、基底部情况的不同采用高频电刀、氩气刀、激光、冷冻、支架置入及放射性粒子植入进行治疗。比较介入治疗前后的气管直径、气促指数,观察介入治疗中和治疗后的并发症。结果 43例甲状腺癌侵犯气管的患者经支气管镜介入治疗,病变部位气管直径由(3.9±1.5)mm增加到(10.6±0.6)mm(t=-17.314,P<0.000 1),气促指数由(3.3±0.7)分降低到(2.3±0.7)分(t=9.274,P<0.000 1)。术中并发症包括出血(46.5%)、声带活动受限(4.7%)和声门水肿(7.0%)。支架置入的患者再狭窄发生率为26.7%。37例随访成功的患者治疗后中位生存期为27个月。经单因素及多因素分析,使用介入方法的种类为预后的独立危险因素(HR=0.261,P=0.036)。使用≥3种方法治疗的中位生存期为47个月,使用2种方法治疗的中位生存期为36个月,使用1种方法治疗的中位生存期为13个月。结论对甲状腺癌侵犯气管,经支气管镜介入治疗可以有效解除气道阻塞,改善气促症状;使用多种介入方法联合治疗预后较好。
Objective To evaluate the clinical effects, complications and prognosis of trachea after bronchoscopic interventional therapy for thyroid cancer. Methods The clinical data of 43 patients with tracheal invasion of thyroid carcinoma admitted to Department of Respiratory Medicine, Changhai Hospital from January 2006 to September 2015 were retrospectively analyzed. According to the type of thyroid carcinoma invading the trachea, the degree of stenosis, the basis of the different parts of the situation using high-frequency electric knife, argon knife, laser, freezing, stent implantation and radioactive seed implantation for treatment. Before and after interventional therapy compared tracheal diameter, shortness of breath index, observed interventional therapy and postoperative complications. Results Thirty-three patients with tracheal invasion of thyroid cancer underwent bronchoscopic intervention. The tracheal diameter of the lesion increased from (3.9 ± 1.5) mm to (10.6 ± 0.6) mm (t = -17.314, P <0.0001) (3.3 ± 0.7) points to (2.3 ± 0.7) points (t = 9.274, P <0.000 1). Intraoperative complications included hemorrhage (46.5%), limited vocal cord activity (4.7%) and glottis edema (7.0%). The incidence of restenosis was 26.7% in stents. The median survival of 37 patients with successful follow-up was 27 months. Univariate and multivariate analysis showed that the type of intervention was an independent prognostic risk factor (HR = 0.261, P = 0.036). Median survival was 47 months for ≥3 treatments, 36 months for both treatments, and 13 months for treatment with one of these treatments. Conclusion Thyroid cancer invading the trachea and bronchoscopic intervention can effectively relieve airway obstruction and improve the symptoms of shortness of breath. The combination of multiple interventions has a good prognosis.