气管隆突部肿瘤的手术体会(附14例报告)

The Experience of the Operation on Carinal Tumor of the Trachea: A Report of 14 Cases

目的:探讨气管隆突部肿瘤的手术方法及早期诊断。方法:总结本院1989年1月至2002年12月14例气管隆突部肿瘤或中心性肺癌累及隆突的手术方法、病理及预后。其中良性病变3例,低度恶性肿瘤4例,余7例为腺癌和鳞癌。一侧全肺加隆突切除2例,右肺上叶加隆突切除重建2例,不切肺叶单行隆突切除重建8例,姑息切除1例,手术探查1例。结果:所有病例手术过程顺利。1例肿瘤累及食管,术后发生吻合口瘘,后治愈。2例术后发生吻合口肉芽肿而狭窄,经微波治疗治愈。余无严重并发症。结论:绝大部分病例可单纯切除气管下段及两侧主支气管近端,将病变切除而不切除肺叶。少数病例可连同一侧的肺上叶切除而不行全肺切除。只有较晚期的中心型肺癌同时累及隆突及中间支气管才行全肺加隆突切除,而此种手术不必切断对侧支气管的外侧壁。

Objective： To study the surgical methods and early diagnosis of carinal tumor. Methods： Fourteen cases were studied, including 3 benign lesions, 4 tumors with low potential malignancy, and the others were adenocarcinoma or squamous carcinoma. In our study, there were 2 cases with pneumonectomy plus carina resection, 8 carina resection and reconstruction without lohectomy, 1 palliative resection and 1 exploration. Results： All of the operations were smoothly performed. The fistula of anastomotic stoma occurred in 1 case because of the tumor involvement in the esophagus. Anastomotic stoma granuloma was found in 2 cases. All the complications healed well. Conclusions： It is feasible in most cases to resect the inferior segment of the trachea and the proximal segmental of the bilateral main bronchus, and the pulmonary lobe was remained. Lobectomy is needed in some cases, pneumonectomy is necessary only in a few cases with advanced carcinoma, in which key out of the lateral wall of other side bronchus is unnecessary.