支气管镜介入治疗原发性气管肿瘤的临床分析

Original ArticleClinical analysis of therapeutic bronchoscopy for tracheal neoplasm

目的分析原发性气管肿瘤的临床特点，探究支气管镜介入治疗原发性气管肿瘤的疗效。方法回顾性分析第二军医大学附属长海医院2004年1月至2014年7月经支气管镜介入治疗43例原发性气管肿瘤患者的临床资料及疾病谱，观察介入治疗前后气道狭窄程度、气促评分及Karnofsky功能状态评分（KPS）的变化，随访2年的生存状况并评价其疗效。结果43例原发性气管肿瘤患者从出现气道阻塞症状至确诊所间隔时间平均为（4.6±3.9）个月，首次就诊的漏诊率为41.9%（18/43），最常误诊为支气管哮喘（11/43）。成人气管恶性肿瘤较良性肿瘤多见，以鳞癌和腺样囊性癌为主。介入治疗后，6例气管良性肿瘤腔内病灶完全清除，37例恶性肿瘤患者腔内病灶均完全或部分被切除，呼吸困难症状减轻（总体有效率100%）。43例患者的气促评分由治疗前（3.2±0.7）级减少至治疗后（1.5±0.8）级（t＝6.63，P〈0.05）。KPS由治疗前的63±12増加至治疗后的83±11（t＝5.78，P〈0.05）。6例气管良性肿瘤2年生存率为100%，期间1例乳头状瘤治疗后出现复发。37例气管恶性肿瘤1年生存率为59.5%，2年生存率为43.2%，中位生存期为13.6个月。结论支气管镜介入治疗可有效疏通气管肿瘤的气道，减轻气促症状，改善体力状况。

Objective To analyze the clinical features in adults with tracheal neoplasm and to evaluate the efficacy of interventional bronchoscopic treatment.Methods We retrospectively analyzed the clinical features of 43 adults undergoing therapeutic bronchoscopy for tracheal neoplasm diagnosed in Changhai Hospital affiliated to the Second Military Medical University from January 2004 to July 2014.The degree of stenosis, the grade of dyspnea, and Karnofsky performance status scale were evaluated before and after the last procedure. All cases were followed up for 2 years.Results The 43 cases took （4.6±3.9） months on average to be diagnosed since initial symptom. The initial misdiagnosis rate was 41.9%（18/43）, and 11 cases were mistaken for asthma （11/43）. Malignant tumors were more common than benign tumors for tracheal neoplasm in adults. Squamous cell carcinoma and adenoid cystic carcinoma were the top 2 histological types. Central airway obstruction was completely or partially alleviated with significant relief of dyspnea after the procedures, and all 6 cases of tracheal benign tumors got complete alleviation （the overall response rate was 100%）. The grade of dyspnea was 3.2±0.7 before and 1.5±0.8 after the procedures（t=6.63, P〈0.05）. The value of KPS was 63±12 before and 83±11 after the procedures（t=5.78, P〈0.05）. The 2-year survival rate of 6 cases of tracheal benign tumors was 100.0%, and 1 case of papillomatosis had a relapse. The 1-year survival rate and 2-year survival rate of 37 cases of tracheal malignant tumors were 59.5% and 43.2% respectively with a median survival of 13.6 months.Conclusion Therapeutic bronchoscopic interventions provide significantly alleviation of central airway obstruction and result in improvement in shortness of breath and quality of life for tracheal neoplasm.