支气管镜下不同方式治疗气管腺样囊性癌的疗效比较

lnterventional therapy by bronchuscope on trachea adenoid cystic carcinoma in end stage

目的评价支气管镜下不同方式治疗气管腺样囊性癌（TACC）的临床疗效和并发症。方法回顾性分析煤炭总医院呼吸科自2008年1月至2012年10月收治的TACC患者共25例，比较不同支气管镜下治疗方法在治疗前后的气管直径、气促指数，并观察治疗后的并发症。结果所有患者经治疗后症状均改善，气管直径由术前的（56±1．6）mm升高至（13．2±1．5）mm，气促评分由术前的2．8±0．8降至1．7±0．5（P〈0．01）。术后各组患者均存在轻度咳嗽、咯血、咽痛，可自行缓解；支架置人组及125I粒子植入组部分患者出现胸痛，可自行缓解。远期并发症主要为肿瘤复发导致的气管再狭窄，术后定期行气管镜检查随访，术后1个月、3个月氩等离子体凝切术（APC）＋CO2冷冻＋125I粒子植入组的再狭窄例数低于其他组。结论支气管镜下不同治疗方式均可以改善TACC患者的症状，不同治疗方式的近期疗效无统计学差异，APc＋CO2冷冻＋125I粒子植入组患者再狭窄的几率可能更低。

Objective To evaluate clinical curative effect and complications of different interventional methods by bronchoscopy on trachea adenoid cystic carcinoma （TACC）. Methods The data of 25 patients with TACC in Meitan general hospital from January 2008 to October 2012 were retrospectively analyzed. The trachea diameter and dyspnea index were compared before and after treatment. Results The symptoms of all patients were improved after treatment. The trachea diameter increased significantly from （5.6±1.6） mm to （13.2±1.5） mm （P〈0.01）,and the dyspnea index decreased dramatically from 2.8±0.8 to 1.7±0.5 （ P 〈0.01）. Cough, haemoptysis,pharynx pain were the general complications following treatments. Trachea restenosis due to tumor relapse was major long term complication. The incidence of trachea restenosis in 125I radioactive seed implantation group was lower compared with the other groups during one month and three months follow-up. Conclusions The signs and symptoms were improved with different interventional methods by bronchoseopy in patients with TACC. The incidence of trachea restenosis may be low when patients receiving argon plasma coagulation, CO2 cryosurgery and 125I radioactive seed implantation.