摘要
目的 探讨原发性气管恶性肿瘤的临床特点及诊治方法 。方法 回顾性分析广州医科大学附属第一医院2009年1月-2013年12月确诊为原发性气管恶性肿瘤的患者临床资料。结果 本研究共纳入48例患者,占同期病理确诊的胸部恶性肿瘤的0.93%（48/5155）;其中,男26例,女22例,年龄6-76岁,平均（50.06±18.34）岁,其中,40-50岁10例（20.8%）和60-70岁15例（31.3%）,症状主要为咳嗽（72.9%）、气促（58.3%）、咯血痰（29.1%）,所有患者颈部均可闻及干啰音;17例（35.4%）早期误诊;26例（54.2%）的胸部X线可发现病灶,胸部CT均能见病灶,病变位于气管上段15例（31.2%）、中段9例（18.7%）、下段24例（50.0%）。35例经支气管镜诊断,13例经外科手术诊断。18例（37.5%）为腺样囊性癌,17例（35.4%）为鳞状细胞癌。临床分期中Ⅰ期占20.8%,Ⅱ期占12.5%,Ⅲ期占25.0%,Ⅳ期占41.7%。经支气管镜治疗28例,其中放置支架13例,其他方法包括圈套器切割、APC、高频电刀、冷冻等,14例采用外科手术,11例采用化疗,9例采用放疗,8例放弃治疗。所有手术后患者全部随访,1例术后感染死亡,其余13例均存活。结论 原发性气管恶性肿瘤发病率较低,临床表现不具有特征性,容易误诊,诊断主要根据CT和支气管镜,诊断时多数已属于晚期,病理类型主要为腺样囊性癌和鳞癌。支气管镜局部治疗和手术是主要的治疗手段,手术治疗者预后较好。
Objective To explore the clinical features,diagnoses and treatment of primary malignant tracheal tumors.Methods Clinical data of patients diagnosed with primary malignant tracheal tumors in the First Affiliated Hospital of Guangzhou Medical University from January 2009 to December 2013 were collected and analyzed retrospectively. Results 48 patients were included in this study and accounted for 0.93%（48/5155） of all chest malignant cancer during the same period,male had 26 cases,female had 22 cases,the average age was（50.06±18.34） years（aged ranging from 6 to76）. 10 patients（20.8%） aged from 40 to 50,and 15 patients（31.3%） aged from 60 to 70 accounted for the majority of the total number. The main clinical symptoms were cough（72.9%）,shortness of breath（58.3%） and hemoptysis（29.1%）. Rhonchus at neck could be heard in all patients. 17 cases（35.4%） were misdiagnosed at the early stage of disease. 26 cases（54.2%）could be detected the lesions from X-ray,while all the lesions could be detected by chest CT scan,15 cases（31.2%） in the upper part of the trachea,9 cases（18.7%） in the middle and 24 cases（50.0%） in the lower part. 35 cases diagnosed by bronchoscope while 13 cases diagnosed by surgical biopsy. The major pathological classifications of primary malignant tracheal tumors were adenocystic carcinoma and squamous-cell carcinoma（37.5% and 35.4%,respectively）. Tumor stageⅠ accounted for 20.8%,stage Ⅱ for 12.5%,stage Ⅲ for 25.0% and stage Ⅳ for 41.7%. 28 cases received interventional treatment by bronchoscope,of whom,13 cases given stent placement treatment,others included incision,stenting,APC,electrocautery and cryotherapy,while 14 cases received surgery,11 cases received chemotherapy,9 cases received radiotherapy and 8 cases given up their treatments. At the follow-up 14 cases received surgery,1 case died for infection,while13 cases had still survival. Conclusion Primary malignant tracheal tumors have low prevalence,presents with non-specific clinical signs and is easy to misdiagnose. Diagnosis of primary malignant tracheal tumors mainly bases on CT and bronchoscopy,whereas the majority of patients are late-stage tracheal carcinoma when first diagnosis. The major pathological classification of primary malignant trachea tumors are adenocystic carcinoma and squamous-cell carcinoma,interventional operation by bronchoscope and surgical resection are the main treatment for tracheal tumors,and the prognosis that treating by surgery is well.
出处
《中国医药导报》
CAS
2015年第31期82-84,92,共4页
China Medical Herald
基金
国家卫生和计划生育委员会公益性行业专项项目(201402024)
关键词
气管
原发性
恶性肿瘤
支气管镜
手术
Trachea
Primary
Malignant tumor
Bron-choscopy
Surgery
