支气管肺类癌的诊断及治疗

Diagnosis and Therapy of Bronchopulmonary Carcinoid Tumors

支气管肺类癌是罕见的肺部肿瘤,总体生长缓慢、预后尚可。根据其临床特征往往可以推测支气管肺类癌的诊断和亚型并指导治疗。其中年轻、CT表现为中心型肿瘤且无肺门或纵隔淋巴结肿大的病例,典型类癌的可能性较大。此亚型远处转移几率小,在手术治疗前除胸增强CT外可以不进行其它的常规术前分期检查。中心型肿瘤临床怀疑纵隔淋巴结累及或周围型肿瘤临床怀疑肺门纵隔淋巴结累及的病例,可能为不典型类癌。此亚型应做全面术前评估和分期。累及纵隔淋巴结的不典型类癌预后相对较差,应行多学科积极治疗。支气管肺类癌虽然其生物学特性不活跃,但均为恶性肿瘤,放化疗效果差,手术切除是最主要的治疗手段。彻底切除肿瘤、最大限度保留正常的肺组织是此类肺肿瘤外科治疗的基本目标。

Bronchopulmonary carcinoid tumors are relatively uncommon neoplasms and typically benign and slow growing.However,more aggressive subtypes may develop early nodal and distant metastases.The clinical presentation allows prediction of the diagnosis and cell type and directs evaluation and treatment.Young age,central tumor,and no nodal enlargement are highly suggestive of typical carcinoid.These patients require no further diagnostic or staging tests beyond chest computed tomography and bronchoscopy before resection.For a high suspicion of atypical carcinoid （central cN2,peripheral cN1,2）,imaging for distant,metastases and mediastinoscopy is suggested,with multimodality treatment for an atypical carcinoid with N2 involvement.Because these tumors are generally resistant to chemotherapy,complete surgical resection is the primary form of therapy.Long-term survival for patients with typical carcinoid is excellent but is decreased in those with the atypical subtype.Complete tumor resection with preservation of uninvolved pulmonary parenchyma remains the fundamental goal in the surgical treatment of this unusual clinical entity.