- 期刊
Interventional Bronchoscopy for Treatment of Tracheal Obstruction Secondary to Malignant Thyroid Disease-A Case Report
利用介入性支氣管鏡治療甲狀腺惡性腫瘤所導致的氣管阻塞－病例報告
摘要
惡性的甲狀腺疾病可以導致上呼吸道的阻塞；造成氣道阻塞的機轉包括由氣管外部的壓迫，腫瘤長到氣管內，或兩者共同造成。細胞分化良好的甲狀腺癌通常有較好的預後，而它造成氣道阻塞的機會較少。然而，假如細胞分化良好的甲狀腺癌(well-differentiated thyroid cancer)已造成了氣管的侵犯，它通常代表預後不佳。治療分化良好的甲狀腺癌所造成的氣管侵犯，手術切除合併氣管重建仍是主要的治療方式。在技術上或身體狀況無法接受手術的病人，若合併有症狀的氣道阻塞，需考慮其他形式的緩和療法。近來，隨著技術的進步，對於甲狀腺癌導致氣管阻塞的病人，介入性支氣管鏡合併支架置放可以提供較長期的氣道通暢度。 我們報告了一位86歲的女性病患，因為甲狀腺乳突狀腫瘤(thyroid papillary carcinoma)導致的氣管阻塞，以喘鳴音(stridor)來表現。她在接受介入性支氣管鏡檢查合併支架置放後，她的喘鳴獲得了立即的改善。因此，在甲狀腺癌所導致的氣管阻塞而又無法開刀的病患，介入性支氣管鏡檢查合併支架置放是一項有用的替代療法。
並列摘要
Malignant thyroid disorders can cause upper and central airway obstruction. The mechanisms of airway obstruction include extrinsic tracheal compression, tracheal ingrowth, or a combination thereof. Well-differentiated thyroid cancer (WDTC) usually has a better prognosis, but is a less frequent cause of thyroid-induced airway obstruction. However, if WDTC-related tracheal invasion occurs, it is usually associated with a poor prognosis. Surgical resection with tracheal reconstruction remains the mainstay of management of WDTC-related tracheal invasion. In cases with technically or medically inoperable patients with malignant symptomatic airway obstruction, some form of palliative treatment should be considered. Due to recent technical improvements, interventional bronchoscopy with stent placement may provide longstanding airway patency for thyroid cancer-related tracheal obstruction. We report an 86-year-old female patient presenting stridor because of thyroid papillary carcinoma-related tracheal obstruction. After receiving interventional bronchoscopy with an Ultraflex tracheal stent placement, her stridor symptoms immediately improved. Thus, interventional bronchoscopic procedures with stent implant are valuable alternatives to surgery in inoperable thyroid cancer-induced tracheal obstruction.
延伸閱讀
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