甲狀舌管癌的診治分析

徐蓉　朱新　黃志純

【摘要】 目的 探討甲狀舌管癌的臨床特點、診治及預后。方法 回顧性分析4例甲狀舌管癌患者的臨床資料， 結合文獻探討其臨床、病理特點及合理的治療方案。4例患者術前均診斷為甲狀舌管囊腫， 術后病理診斷為甲狀舌管癌。4例患者均行手術治療， 2例接受Sistrunk術式（切除范圍包括腫物、甲狀舌管殘余及部分舌骨）， 1例患者行Sistrunk術式+甲狀腺右葉及峽部切除術， 1例行Sistrunk術式+

甲狀腺全切除術+左側頸淋巴結及中央區淋巴結清掃術。觀察效果。結果 4例患者術中、術后均未出現并發癥， 傷口愈合良好， 按期拆線。1例行Sistrunk術式+甲狀腺右葉及峽部切除術的患者， 隨訪36個月后發現右側頸淋巴結腫大， 給予行右側頸淋巴結清掃術+甲狀腺左葉切除術， 術后證實甲狀舌管癌頸淋巴結轉移， 行放射性碘治療， 隨訪至今， 生存無復發。其余3例患者術后隨訪時間為22～120個月， 至隨訪截止， 患者均生存， 且均無腫瘤復發轉移。結論 甲狀舌管癌臨床罕見， 確診有賴于病理檢查， 外科手術是主要的治療手段， 術后需要密切隨訪。

【關鍵詞】 甲狀舌管囊腫；乳頭狀癌；診斷；手術

DOI：10.14163/j.cnki.11-5547/r.2017.25.002

【Abstract】 Objective To investigate the clinical features， diagnosis and prognosis of thyroglossal duct carcinoma. Methods The clinical data of 4 cases with thyroglossal duct carcinoma were analyzed retrospectively. The clinical and pathological features and reasonable treatment protocols were discussed. 4 cases were diagnosed as thyroglossal duct cyst before operation， and thyroglossal duct carcinoma by pathological diagnosis. 4 patients received surgical treatment， including 2 cases of Sistrunk surgery （tumor resection including thyroglossal duct residual and hyoid bone）， 1 case of Sistrunk surgery + thyroid right lobe and isthmus resection， 1 case of Sistrunk surgery + total thyroidectomy + left cervical lymph node and central area lymph node dissection. The effect was observed. Results 4 patients had no complications during the operation or after operation. The wound healed well and the stitches were removed on time. 1 patient with Sistrunk surgery + thyroid right lobe and isthmus resection showed right cervical lymph node enlargement in 36 months of follow-up， and the right cervical lymph node dissection + thyroid lobectomy were performed. The cervical lymph node metastasis of the thyroglossal duct was confirmed after operation， and radioactive iodine treatment was performed. No recurrence has been observed so far. The remaining 3 patients were followed up for 22～120 months， and until the deadline for follow-up， all patients survived. There were no tumor recurrence and metastasis. Conclusion The thyroglossal duct carcinoma is rare in clinic， and comfirmed diagnosis depends on pathological examination. Surgical treatment is the main treatment and needs to be closely followed-up after operation.

【Key words】 Thyroglossal carcinoma； Papillary carcinoma； Diagnosis； Operation

甲狀舌管癌（thyroglossal duct carcinoma， TDCa）是原發于甲狀舌管殘余或甲狀舌管囊腫內的一種罕見的惡性腫瘤[1]。迄今為止， 國外文獻報道200余例[2， 3]， 國內文獻報道較少， 且多以個案報道為主[4-7]。目前， 臨床上對甲狀舌管癌的發病機制、診斷及治療等方面仍存在較大爭議。本研究回顧性分析本院收治的4例甲狀舌管癌患者的臨床資料， 結合相關文獻， 探討其發病機制、診治及預后。……