儿童气管黏液表皮样癌的外科治疗

Surgical treatments of tracheobronchial mucoepidermoid carcinoma in children

目的总结儿童气管黏液表皮样癌的临床特征及外科治疗经验。方法收集2009年1月至2021年6月首都医科大学附属北京儿童医院胸外科收治的全部气管黏液表皮样癌21例患儿的临床资料,其中男14例,女7例;中位手术年龄为9.9(4.2~13.5)岁。临床表现为呼吸道感染15例,咯血7例,胸痛1例,无症状1例。胸部CT主要表现为气管占位、肺炎、肺不张、肺气肿。在评估气管黏液表皮样癌时,如果其血运丰富(CT值≥100),在行支气管镜活检前需行肿瘤供血血管介入栓塞术。如果病理类型是低级别且肿瘤局限于气道内、位于段级以上支气管的肿瘤,首先采用支气管镜介入治疗;如果病理类型是高级别,或侵犯周围脏器和淋巴结、或位于段级及以下的肿瘤均需手术治疗。结果21例均完整切除肿瘤并获得阴性切缘,病理诊断为支气管黏液表皮样癌低级别19例,高级别2例。1例患儿术后出现持续低氧饱和,其余患儿术后均顺利出院。19例患儿获得随访,2例因更换了联系方式而失访。中位随访时间为43(2~146)个月,均未见复发及转移。结论儿童气管黏液表皮样癌以呼吸道感染和咯血为主要表现,手术切除是主要治疗方式,预后良好。

Objective To summarize the clinical features and surgical options of tracheobronchial mucoepidermoid carcinoma(MEC)in children.Methods Clinical data were retrospectively reviewed for 21 children with tracheobronchial mucoepidermoid carcinoma admitted into the Department of Thoracic Surgery at Beijing Children's Hospital from January 2009 to June 2021.There were 14 boys and 7 girls with an average age of 9.2(4.2-13.5)year.Clinical manifestations included respiratory tract infection(n=15),hemoptysis(n=7),chest pain(n=1)and asymptomatic(n=1).Chest computed tomography(CT)hinted at tracheobronchial space-occupying,pneumonia,atelectasis and emphysema.For tracheobronchial mucoepidermoid carcinoma,if blood supply was rich(CT value≥100),interventional embolization of tumor blood supply vessel should be performed prior to bronchoscopy.If low-grade tumor was confined to airway and located in bronchi above segment level,bronchoscopic interventional therapy was performed initially.If pathological type was high-grade,invading surrounding organs and lymph nodes or tumor were located at or below segment level,surgery was required.Results After a complete resection,pathological diagnosis was bronchial mucoepidermoid carcinoma of low-grade(n=19)and high-grade(n=2).All of them were discharged successfully post-operation.During a mean follow-up period of 53.6 months,there was no recurrence or metastasis.Conclusions The major manifestations of mucoepidermoid carcinoma in children are respiratory tract infection and hemoptysis.Surgical resection remains a mainstay and the prognosis is decent.