肺癌术后气管／支气管内转移临床分析

Clinical analysis of endotracheal/endobronchial metastases after surgical resection of primary lung cancer

目的分析肺癌术后气管／支气管内转移的临床及病理特征，探讨并总结其诊治方法，改善患者预后。方法回顾性分析3例肺癌术后气管／支气管内转移患者及自1990年以来文献报道组织病理确诊13例患者的病例资料，并复习相关文献。结果气管／支气管内转移男性常见（14／16），无症状患者均术后复查发现，存在临床症状者主要表现为咳嗽（9／16）、痰血（8／16），偶有气促（3／16）。转移部位多发生于气管（14／16），转移病灶单发占67％（10／16），病理类型以鳞癌为主（13／16），腺癌（3／16）；术后转移平均间隔时间23．6个月。再次手术病灶切除5例，放化疗2例，放疗5例，化疗4例，再次手术及放疗患者平均生存时间高于单纯放疗或化疗。结论肺癌术后气管／支气管内转移极易漏诊，需重视术后影像随访，发现气管／支气管壁异常结节或增厚，尤其伴有呼吸道症状者应及时支气管镜检查排除，再次手术切除和放疗为主要治疗手段，局部治疗可缓解症状，提高生活质量。

Objective To analyze the clinical and pathological characteristics of endotracheal/ endobronehial metastases after surgical resection of primary lung cancer, and to investigate and summarize the methods of diagnosis and treatment to improve the prognosis of patients. Methods Three cases of endotracheal/endobronchial surgecal resection of lung cancer in our hospital and 13 patients with pathological evidences from retrieval literature since 1990 were retrospectively analyzed and the related literatures were reviewed. Results Endotraeheal/endobron ehial metastases in male patients was more frequent （14/16）. Cough（9/16）, hemoptysis（8/16） and polypnea（3/16） were the common symptoms. Bronchoscopic examination revealed that most of lesion occurred in the trachea（14/16）. Solitary lesions were 67% （10/15）. Pathologic type included squamous cell carcinoma （13/16） and adenocarcinoma（3/ 16）. The mean interval time was 23.6 months after operation. Treatment options included surgical resec- tion in 5 cases, radiotherapy in 5 cases, chemoradiotherapy in 2 cases and chemotherapy in 4 cases. The average survival time of the patients undergoing reoperation and chemoradiotherapy was higher than that of radiotherapy or chemotherapy alone. Conclusions Endotracheal/endobronch ial metastases after surgi- cal resection of primary lung cancer is easily misdiagnosed. Great attention should be paid to the postoperative follow-up imaging. Bronchoscopy should be timely taken to exclude postoperative metastases, when abnormal nodules or thickening is found in tracheal/bronchial wall especially among patients with respiratory symptoms. Re-surgical resection and radiotherapy are the main treatment methods. Local therapy can relieve the symptoms and improve the quality of life.