气管肿瘤4例临床分析

Retrospective analysis of four cases of tracheal tumour

目的分析原发性气管肿瘤临床特征,探讨原发性气管肿瘤的误诊原因和提高临床对气管肿瘤的早期诊疗水平。方法对我院经支气管镜检查、组织病理学诊断的原发性气管肿瘤4例临床资料进行分析,并结合文献复习。结果原发性气管癌早期主要临床表现为咳嗽、咳痰、后期可有咯血、活动后胸闷气促、呼吸困难、喘鸣及类似哮喘样表现。胸部X线片2例表现为肺气肿征象,2例正常。胸部CT检查提示腔内结节型2例、腔内结节及管壁弥漫浸润2例。支气管镜检查显示病变在气管上1/3者有1例、气管中1/3者2例、气管下1/3和隆凸弥漫浸润1例。病理类型腺癌2例、未定型1例、纤维瘤1例。误诊为哮喘2例,支气管炎2例。3例肺功能检查提示流量-容积曲线(flow-volume loop F-V)有异常改变。结论原发性气管肿瘤早期缺乏特异性的临床表现,极易漏诊和误诊。F-V检查对气管肿瘤引起的上气道梗阻有重要价值。病变难以在X线胸片上发现,胸部CT可准确反映原发病变的部位和生长方式。支气管镜检查不但能够准确发现气管内肿瘤的部位、形态、大小及管腔受累情况并能够活检取得组织学依据,同时可行镜下治疗,诊断意义最大。加强对本病的认识、积极进行胸部CT检查和纤维支气管镜检查有助于减少误诊。

Objective ＂ To inquiry into clinical character,misdiagnostic cause and method of improving the clinical diagnostic accuracy of primary tracheal tumour at early stage. Methods The 4 cases of primary tracheal tumour in my hospital, confirmed by bronchoscope and pathology , were discussed and the literature was reviewed. Results The early main signs of primary tracheal tumour were cough, sputum and hemoptysis, puff,breathe hard and the same representation as asthma. Chest diography showed em- physema in 2 cases, others were normal. CT imaging manifested that protrusion toward cavities in 2 cases , protrusion toward cavities and diffuse thickening of tracheal wall in 2 cases. BronchoScope found that le- sion was located in upper one-third of tracheal in 1 case, middle one-third of tracheal in 2 cases , lower one-third of tracheal and carina in 1 case. 2 cases had adenocarcinoma , 1 case had undifferentiated, 1 case had fibroma. 2 cases misdiagnozed asthma,2 cases misdiagnozed bronchitis. 3 cases pulmonary func- tion showed flow-volume loop F-V unconventionality. Conclusions Primary tracheal tumour lacked spe- cific symptoms signs at early stage. It were easy misdiagnozed and leave out diagnosis. Flow-volume loop were significance of obstruction in upper tracheal. Primary lesion were not manifested in chest radiography. Growth site and pattern can be identified from CT manifestation. Bronchoscope not only can found the site , shape, size and lesion in tracheal, but also can biopsy to acquired pathological specimen and cure through it ,it is the most significance in diagnosis. So to improve realization of primary tracheal tumour and to positively practice CT and bronchoscope examination can help increase the accuracy of diagnosis at early stage.