气管及其隆突部肿瘤的外科治疗与预后

摘要

Objective To investigate and evaluate the clinical features, diagnostic methods, surgical management of trachea tumors in order to improve patients outcome. Methods Clinical data of 32 patients with trachea tumors surgically treated from June 1986 to June 2005 were retrospectively analyzed. There were 22 male and 10 female patients. The age ranged from 14 to 63 years old with a median of 48 years old. The surgical proeeduros performed were resection and reconstruction of trachea in 10 cases, right or left pneumonectomy and carinal resection and reconstruction in 8 cases, right sleeve upper lobectomy, camial resection and reconstruction of trachea and carina in 8 cases, and carina resection and reconstruction with tumor removal through tracheal windows 6 cases. The tracheal defect was repaired with a Teflon flap in two patients. Cardiopulmonary bypass was used in 2 patients during surgery. Results The histological examination of resected lesions revealed squamous cell carcinoma in 19 cases, asenoid cystic carcinoma in 8 cases, adenocarcinpma in 2 cases, carcinoid in 2 cases, leiomyosarcoma in 1 case and adenoma in 1 case. One case had infection of thoracic cavity and 3 cases experienced temporary cardiac arrhythmia. There was no operative death. The follow-up periods were from 5 months to 3 years. The 1,2 and 3 year survival rates were 93.7%, 59. 4% and 50. 0% respectively. Conclusions Squamous cell carcinoma adenoid cystic carcinoma are the most common in trachea tumors. Preoperative bronchoscope examination and chest CT scan can provide valuable diagnostic data. Proper choice of surgical procedure is important for improved patients' outcome.%目的 总结分析气管及其隆突部肿瘤的临床表现、诊断、手术方法以及预后.方法 回顾性分析1986年6月至2005年6月手术治疗的32例气管及其隆突部肿瘤患者的临床资料,其中男性22例,女性10例,年龄14～63岁,中位年龄48岁.32例患者中气管肿瘤切除+端端吻合10例;全肺隆突切除+气管与主支气管端端吻合8例(右侧6例,左侧2例);右上肺隆突袖式切除重建术4例;隆突切除重建术4例;气管开窗行肿瘤及气管壁部分切除6例,其中2例因气管壁切除范围过大,以涤纶布内衬修补.结果 32例中鳞状细胞癌19例,腺样囊腺癌8例,腺癌2例,类癌1例,平滑肌肉瘤1例,腺瘤1例.手术并发症包括术后1例胸腔感染,3例出现心律失常.全组患者无手术死亡.随访时间5个月～3年,随访率100%.Kaplan-Meier法计算1、2和3年生存率为93.7%、59.4%和50.0%.结论 鳞状细胞癌和腺样囊性癌是气管及其隆突部肿瘤最常见的组织类型,术前气管镜和CT可帮助诊断,手术方式的正确选择是提高治疗效果的关键.