原发性气管肿瘤八例临床分析

Clinical characteristics of 8 cases of primary tracheal tumors

目的探讨原发性气管肿瘤患者的临床特点及诊治方法，提高该病的临床诊治水平。方法回顾性分析浙江大学医学院邵逸夫医院1994年5月至2006年5月收治的8例原发性气管肿瘤患者的临床资料，对其中4例的临床表现、胸部影像学特点、支气管镜下所见、肺功能、治疗及预后转归进行分析并复习相关文献。结果8例中男6例，女2例，年龄26～73岁，其中7例表现为刺激性咳嗽及逐渐加重的以吸气相为主的呼吸困难，多数被误诊为支气管哮喘或慢性支气管炎。8例均经支气管镜检查确诊。1例良性神经鞘瘤及2例腺样囊性癌手术后长期缓解，2例管腔高度狭窄的鳞癌患者经支气管镜植入支架并进行氩等离子凝固治疗后症状迅速缓解，1例腺样囊性癌患者拒绝治疗，1例鳞癌患者术后失访，1例腺癌患者病情持续恶化并于确诊2个月后死亡。结论原发性气管肿瘤早期症状无特异性，对于持续性咳嗽及呼吸困难且常规治疗不能缓解的患者应高度怀疑气管肿瘤的可能，及早行胸部CT及支气管镜检查可提高确诊率。气管良性肿瘤可手术切除，部分低度恶性肿瘤经手术及术后放疗可长期存活，不能手术切除的恶性肿瘤也可采取经支气管镜介入治疗改善症状，提高生活质量。

Objective To explore the clinical characteristics of primary tracheal tumors and therefore to improve the diagnosis and treatment. Methods A retrospective analysis of the clinical data of 8 patients with primary tracheal tumors admitted to our department during the period of May 1994 to May 2006 was performed, with detailed description of the clinical manifestations, chest radiography, fiberoptic bronehoscopy, lung function measurements, treatment and prognosis for 4 cases. Results Seven patients presented with irritable cough and progressive inspiratory dyspnea, mostly misdiagnosed as asthma or chronic bronchitis. Examination by fiberoptic bronchoscopy confirmed the diagnosis of tracheal tumor in all the cases. One case with benign neurinoma and 2 cases with adenoid cystic carcinomas had a long-term postoperative remission. Two cases of squamous cell carcinoma with severe tracheal stenosis got rapid symptom remission after intervention of tracheal stent by fiberoptie bronchoscopy and argon plasma coagulation. One patient with adenoid cystic carcinoma refused any treatment. One patient with squamous cell carcinoma lost follow-up after surgery. One patient with adenocarcinoma died of progressive deterioration after 2 month chemotherapy. Conclusions Primary tracheal tumors occur infrequently and early clinical symptoms are unspecific. Early diagnosis can be made by chest CT and fiberoptic bronchoseopy. Benign tracheal tumors can be resected, and for some low-grade malignant tumors surgical resection and postoperative radiotherapy can improve long term survival. Intervention with fiberoptic bronchoscopy to unresectable diseases can lead to symptom remission and thus improve patient＇s life quality.