Eur Radiol:复发性甲状腺癌一旦侵犯了气管,射频消融治疗效果如何?

2021-03-15 shaosai MedSci原创

甲状腺癌是最常见的内分泌癌。分化型甲状腺癌患者预后较好,死亡率低。然而,有报道称分化型甲状腺癌术后复发率高达30%,局部复发对总生存率和疾病特异性生存率有中度有害

    甲状腺癌是最常见的内分泌癌。分化型甲状腺癌患者预后较好,死亡率低。然而,有报道称分化型甲状腺癌术后复发率高达30%,局部复发对总生存率和疾病特异性生存率有中度有害影响。

    手术切除是局部复发甲状腺癌的标准治疗方法。然而,由于手术后瘢痕组织的形成导致正常组织扭曲和局部严重的纤维化,因此再次手术对外科医生来说挑战性极大。由于再次手术的疗效有限,并且小的复发性肿瘤通常表现为缓慢的临床病程,美国甲状腺协会(ATA)指南推荐治疗性颈部中央区清扫术仅适用于活检证实的持续性复发性病灶和最小尺寸≥8mm的中央区淋巴结。然而,颈部中央区的复发性肿瘤极有可能与对邻近的关键结构紧密粘连或侵犯,如喉、气管、食道、喉返神经(RLN)等,这可能会损伤重要器官功能并影响患者的生活质量。

    射频消融(RFA)被认为是局部复发性甲状腺癌的最佳非手术治疗选择。然而,据我们所知,没有研究评估射频消融治疗颈部中央区复发性甲状腺癌的疗效。


   近日,发表在European Radiology杂志的一项研究评价了射频消融术(RFA)治疗侵犯气道的复发性甲状腺癌的疗效,以及治疗效果与肿瘤与邻近气道之间的关系。

    本研究回顾了2008年1月至2018年12月期间接受射频消融术治疗颈部中央区复发性甲状腺癌的患者。所有肿瘤均按其与喉的结构及气管的关系进行分类。计算体积缩小率(VRR)和完全消失率,并根据肿瘤与气管的相关性确定其差异。评估与RFA相关的并发症发生率。

    本研究纳入119例患者共172例复发肿瘤。平均VRR为81.2%±55.7%,平均随访时间为47.9±35.4个月,124个肿瘤(72.1%)完全消失。完全消失率在未与气管接触的复发肿瘤中最高,其次为与气管形成锐角、直角、钝角和气管腔内侵犯的肿瘤(p值< 0.001)。总的并发症发生率为21.4%。

  

图1 显示复发性肿瘤与气管之间关系的分类的示意图,由左到右分别为与气管形成锐角、直角、钝角和气管腔内侵犯的肿瘤。

表1 复发性肿瘤合并气管腔内侵犯的治疗反应。

    射频消融术可有效且安全的局部控制甲状腺切除术后颈部中央区肿瘤复发的治疗手段,甚至对于侵犯气道的肿瘤来说效果同样显著,因此可作为手术切除的替代疗法。由于RFA的疗效与气道侵犯之间的负相关,提示对于颈部中央区肿瘤复发的患者需行早期RFA干预以提高治疗效果及生活质量。


原始出处:

Sae Rom Chung,Jung Hwan Baek,Young Jun Choi,et al. Efficacy of radiofrequency ablation for recurrent thyroid cancer invading the airways.DOI:10.1007/s00330-020-07283-w

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time=2021-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032839, encodeId=20e4103283927, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Tue Mar 16 00:50:18 CST 2021, time=2021-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1047305, encodeId=ef7a104e305f4, content=疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Tue Mar 16 00:50:18 CST 2021, time=2021-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=948484, encodeId=5b9d94848402, content=怎么获得积分?, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=94485469464, createdName=ms3000000222441688, createdTime=Mon Mar 15 22:00:43 CST 2021, time=2021-03-15, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=1894208, encodeId=b5c318942089e, content=<a href='/topic/show?id=5e456463eee' target=_blank style='color:#2F92EE;'>#治疗效果#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64637, encryptionId=5e456463eee, topicName=治疗效果)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=373a131, createdName=jxrzshh, createdTime=Thu Apr 15 15:50:18 CST 2021, time=2021-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2006239, encodeId=4e1b2006239f1, content=<a href='/topic/show?id=7c8f425485d' target=_blank style='color:#2F92EE;'>#复发性甲状腺癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42548, encryptionId=7c8f425485d, topicName=复发性甲状腺癌)], attachment=null, authenticateStatus=null, 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time=2021-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032839, encodeId=20e4103283927, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Tue Mar 16 00:50:18 CST 2021, time=2021-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1047305, encodeId=ef7a104e305f4, content=疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Tue Mar 16 00:50:18 CST 2021, time=2021-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=948484, encodeId=5b9d94848402, content=怎么获得积分?, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=94485469464, createdName=ms3000000222441688, createdTime=Mon Mar 15 22:00:43 CST 2021, time=2021-03-15, status=1, ipAttribution=)]
    2021-03-16 内科新手

    谢谢梅斯提供这么好的信息,学到很多

    0

  9. 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time=2021-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032839, encodeId=20e4103283927, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Tue Mar 16 00:50:18 CST 2021, time=2021-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1047305, encodeId=ef7a104e305f4, content=疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Tue Mar 16 00:50:18 CST 2021, time=2021-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=948484, encodeId=5b9d94848402, content=怎么获得积分?, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=94485469464, createdName=ms3000000222441688, createdTime=Mon Mar 15 22:00:43 CST 2021, time=2021-03-15, status=1, ipAttribution=)]
    2021-03-16 CHANGE

    疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的

    0

  10. 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time=2021-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032839, encodeId=20e4103283927, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Tue Mar 16 00:50:18 CST 2021, time=2021-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1047305, encodeId=ef7a104e305f4, content=疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Tue Mar 16 00:50:18 CST 2021, time=2021-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=948484, encodeId=5b9d94848402, content=怎么获得积分?, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=94485469464, createdName=ms3000000222441688, createdTime=Mon Mar 15 22:00:43 CST 2021, time=2021-03-15, status=1, ipAttribution=)]
    2021-03-15 ms3000000222441688

    怎么获得积分?

    0

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气道管理是临床麻醉的焦点问题,但是因气管病变带来的气道狭窄往往具有隐匿性的特点,常在重度狭窄时才能出现明显的临床症状,在症状不典型时,往往难以预估,给麻醉诱导气管插管带来了难以预料的风险。本文介绍1例术前无明显呼吸道症状、未诊断气管狭窄全身麻醉诱导的处理和分析。

气管插管时发现会厌巨大肿物一例

患者,女,53岁,体重61公斤,入院诊断为左肾肿物性质待查,拟在全麻下行腹腔镜下左肾部分切除术。患者既往无声音嘶哑,无咽喉部不适,无胸闷憋气。甲颏间距6 cm,Mallampati分级Ⅲ级,麻醉前评估存在喉镜暴露困难,拟用视可尼喉镜行明视插管。

成年男性无喉结患者气管内插管困难1例

患者,男性,55岁,因胃癌于2016年5月14日入院。体重75kg,身高172 cm,部队军人,有过专业体能训练,因“胃癌”拟在全麻下行胃癌根治术,麻醉前访视常规化验,心电图胸透正常。患者无基础疾病,无睡眠呼吸暂停综合征,无麻醉手术史。面部解剖正常,无短小颈假牙等困难插管特征,但无喉结,颈部肌肉高度发达。张口度4 cm,甲颏距离6.5 cm,Mallampati分级为Ⅱ级。麻醉前常规监测无创血压、

胸腔镜下气管肿瘤切除加隆突成形术中气道管理一例

患者,男,40岁,75kg,ASAⅡ级,NYHA-A级,因“痰中带血1月余”入院。患者既往有支气管炎病史,长期吸烟史,约40支/天。入院诊断:咯血原因待查,慢性支气管炎。胸部CT强化+气管三维重建示:气管末端左侧不规则结节(图1);纤维支气管镜检查示:气管末端菜花样新生物,体积约1.8 cm×1.2 cm×1.0 cm,上缘距声门约9.5 cm,下缘距隆突约0.5 cm,触之易出血,气管狭窄程度C

20岁青年气管窄成“一条缝” 上海专家成功打通生命“主干道”

记者15日获悉,一位受肿瘤压迫,气管极度狭窄,只剩“一条缝”的青年小陈,在上海获得生命的希望。