原发性气管主支气管肿瘤及瘤样病变31例分析

Primary tumors and tumor-like lesions of trachea and main bronchus: a clinicopathologic study of 31 cases

目的:探讨原发性气管主支气管肿瘤的临床病理特点。方法:回顾性分析2000年1月-2008年12月徐州医学院附属医院收治的31例气管主支气管肿瘤患者的临床、影像及病理资料。结果:31例气管主支气管肿瘤患者中,男17例,女14例,年龄25～81岁,平均52岁。临床症状依次表现为咳嗽、咳痰、痰血、咯血、喘憋、声嘶、发热等;病程0.5～84个月。临床误诊为哮喘3例,支气管炎3例,咽喉炎1例,肺炎1例。经CT检查发现气管主支气管占位29例,敏感性达93.5%,余2例经纤维支气管镜检出。31例患者行手术治疗;病理结果示恶性肿瘤22例(71.0%),其中腺样囊性癌10例,鳞状细胞癌5例,黏液表皮样癌3例,神经内分泌肿瘤2例,腺泡细胞癌和炎性肌纤维母细胞瘤各1例;9例(29.0%)为良性肿瘤或瘤样病变,错构瘤3例,鳞状上皮乳头状瘤2例,肌上皮肿瘤、血管瘤、纤维上皮性息肉、平滑肌瘤各1例。结论:原发性气管主支气管内肿瘤及瘤样病变少见,易误诊,CT及纤维支气管镜检查是明确诊断的有效方法;病理学类型主要为唾腺来源肿瘤及鳞状细胞癌;手术切除是治疗气管内肿瘤的主要方法。

Objective： To study the clinicopathologic features of primary tumors and tumor-like lesions of trachea and main bronchus. Methods： The clinical, radiologic, and pathologic data concerning 31 surgically treated patients in Affiliated Hospital of Xuzhou Medical College from Jan. 2000 to Dec. 2008 were analyzed retrospectively. Results： The patients included 17 males and 14 females, aged from 25-81 years （median= 52 years）. 17 cases were tracheal tumors and 14 cases were main bronchi tumors or tumor-like lesions. The clinical symptoms were cough, sputum, bloody sputum, hemoptysis, hoarseness, and fever, 8 cases were misdiagnosed as asthma, bronchitis, pharyngitis and pneumonia. Among the 31 patients, 29 cases （93.5%） were diagnosed as occupying lesions in trachea or main bronchus, the other 2 cases were diagnosed as tracheal tu- mor by bronchoscopy. All the patients were surgically treated. Pathologically, 22 cases （71.0%） were malignant tumors, and the others（29.0%） were benign lesions. The former included adenoid cystic carcinomas（10 cases）, squamous cell carcinomas（5 cases）, mucoepidermoid carcinomas（3 cases）, neuroendocrine tumors（2 cases）, acinar cell carcinoma（1 case）, inflammatory myofibroblastic tumor（1 case）, the later included hamartomas（3 cases）, squamous cell papillomas（2 cases）, myoepithelial tu- mor, hemangioma, leiomyoma and fibroepithelial polyp. Conclusions： Primary tumors and tumor-like lesions of trachea and main bronchus are rare and easily misdiagnosed. CT and bronchoscopy are useful means to identify them. The tumors origined from salivary gland and sqamous cell carcinoma are the most commom tumors in trachea and main bronchus. Surgery is the usful measure to treat them.