原发性支气管肺类癌8例临床分析

Clinical analysis of eight cases of primary bronchopulmonary carcinoid

目的了解支气管肺类癌的临床特点、生物学特性,探讨合理的手术指征及更好的综合治疗方式。方法结合文献回顾性分析1988年3月～2003年7月我院收治的8例支气管肺类癌的临床资料。结果本组典型类癌7例,非典型类癌1例,均未发现类癌综合征。临床表现与肺癌比较缺乏特征性。影像学检查中心型5例,周围型3例;病灶位于主支气管者均引起狭窄,位于段支气管以下者表现为分叶状球形影,密度均匀,边缘光滑。患者均行完全手术切除加淋巴结清除术,石蜡切片及免疫组化染色明确诊断。结论类癌属于神经内分泌癌,典型类癌恶性程度较低,非典型类癌恶性程度介于典型类癌和小细胞癌之间。典型类癌的治疗方式应采用非小细胞肺癌的治疗方式,即完全切除加淋巴结清除再加辅助化放疗。

Objectives To study the clinical and biologic characteristics of bronchopulmonary carcinoid and to find out the rational surgical indications and better approaches of combined treatment.Methods Coupled with other authors' reports, the clinical data of 8 cases of bronchopulmonary carcinoid that we treated during Mar.1988 to Jul. 2003 were reviewed and analyzed.Results In the present group, there were 7 cases of typical carcinoid, 1 case of atypical carcinoid.No carcinoid syndrome was found.Compared with lung cancer,the carcinoid had little characteristic clinical representation. With radiography,5 cases of central type and 3 cases of peripheral type were found.Stricture resulted if the focus was located in the principal bronchus.The carcinoid presented lobulated, spherical and uniform image with smooth margin if it was located below segmental bronchus. The fibrobronchoscope biopsy was not perfect because it only found 1 case of carcinoid. All the cases received radical surgical resection and lymph node clearing and were diagnosed by paraffin section and immunohistochemical staining.Conclusions Carcinoid belongs to neuroendocrine tumor. The malignant degree of typical carcinoid is low and the degree of malignant of atypical carcinoid is between typical carcinoid and small cell lung cancer.The treatment of typical carcinoid should be resection,clearing of lymph nodes, and adjuvant chemotherapy.