气管内介入治疗中央气管腺样囊性癌的临床价值

Clinical value of interventional bronchoscopy in treatment of central airway adenoid cystic carcinoma

目的：评价经支气管镜气管内介入治疗对中央气管腺样囊性癌的临床价值。方法对16例经支气管镜介入治疗和14例外科手术治疗的中央气管腺样囊性癌患者的临床资料进行回顾性分析。比较介入治疗组在经支气管镜介入治疗前后的气管直径、气管狭窄率、气促指数，并观察患者肿瘤复发时间、生存期，并与外科手术组作对比。结果所有患者经治疗后呼吸困难症状明显改善，介入治疗组治疗后气管直径较治疗前明显增加（P＜0.01），狭窄率明显下降（P＜0.01），气促指数明显降低（P＜0.05）。介入治疗组治疗后气管直径、狭窄率、气促指数与外科手术组比较差异均无统计学意义（P均＞0.05）。随访12～48个月，两组术后复发率比较差异无统计学（P＞0.05）。两组术后复发者均予以介入维持治疗，组间介入维持治疗次数和临床稳定时间比较差异无统计学意义（P均＞0.05）。结论对于无外科手术指征或严重呼吸困难的中央气管腺样囊性癌，气管内介入方法是迅速改善气管狭窄的有效方法；对于手术或介入术后局部复发者以介入方法维持治疗亦有较好疗效。

Objective To evaluate the clinical value of interventional therapeutic bronchoscopy in treatment of central airway adenoid cystic carcinoma. Methods Clinical data of 16 patients with central airway adenoid cystic carcinoma treated by interventional therapeutic broncboscopy and 14 patients treated surgically were retrospectively analyzed. Tracheal diameter, rate of tracheal stenosis and dyspnea index were statistically compared before and after bronchoscope intervention. Tumor recurrence and survival time of patients were also observed. Then the indexes were compared between two groups. Results The symptoms of dyspnea were alleviated in all patients after corresponding treatment. In the interventional bronchoscopy group, tracheal diameter was increased （P 〈 0. 01 ）, rate of tracheal stenosis was reduced （P 〈 0. 01 ） and dyspnea index was decreased （ P 〈 0.05 ）. Tracheal diameter, stenosis rate and dyspnea index did not significantly differ between two groups （all P 〉 0. 05）. After 12 -48 months follow-up, postoperative recurrence rate did not significantly differ between two groups （ P 〉 0. 05 ）. Recurrent patients of two groups all underwent interventional maintenance thera- py. Frequency of interventional maintenance therapy and stable clinical time did not significantly differ between two groups （ all P 〉 0. 05）. Conclusion For central airway adenoid cystic carcinoma patients with no surgical indications or severe dyspnea, interventional bronchoscopy is an efficacious and rapid method for alleviating airway stenosis. For locally recurrent patients after surgical or interventional therapy, interventional therapeutic bronchoscopy exerts a relatively high efficacy.