原发性气管肿瘤的临床特点及支气管镜的应用
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摘要
目的总结各种类型原发性气管肿瘤的临床特征、内镜下特点,指导临床诊治。方法回顾性分析2009年1月至2015年12月于中国医学科学院肿瘤医院内镜科行支气管镜检查的病例,收集原发性气管肿瘤患者的临床、内镜及病理资料。结果原发性气管肿瘤共48例,病理类型以腺样囊性癌和鳞癌多见,共占(64. 6%);临床表现主要为气短、咳嗽、痰中带血等,多数患者可闻及哮鸣音; CT检查敏感性达93. 8%,镜下活检诊断率达92. 9%;镜下气管肿瘤可发生于气管各部位,长度不均,形态多样,恶性肿瘤可为隆起性、息肉样和菜花样,表面可有粗糙和坏死,良性肿瘤表面光滑、完整,无粗糙和坏死; 33例(68. 75%)患者管腔狭窄50%以上。结论原发性气管肿瘤发生率低,临床症状、体征缺乏特异性,主要病理类型主要为腺样囊腺癌及鳞癌;良、恶性肿瘤表面特点和累及范围不同,镜下可鉴别;支气管镜检查是确诊的重要方法。
Objective To summarize clinical characteristics and endoscopic features of various types of primary tracheal tumors,so as to guide clinical diagnosis and treatment. Methods Clinical,endoscopic and pathological data of patients with primary tracheal tumors who underwent bronchoscopy from January 2009 to December 2015 in Endoscopy Department of Tumor Hospital of Chinese Academy of Medical Sciences were collected and retrospectively analyzed. Results There were 48 cases of primary tracheal tumor. Adenoid cystic carcinoma and squamous cell carcinoma were the most common pathological types,accounting for 64. 6%. The main clinical manifestations were shortness of breath,cough,blood in sputum and so on,and wheezing sound appeared in most patients; the sensitivity of CT examination was 93. 8%,and the diagnostic rate of biopsy under microscope was 92. 9%. Endoscopic tracheal tumors could occur in all parts of trachea with uneven lengths and various forms. Malignant tumors could be protuberant,with pattern of polypoid and cauliflower,moreover,the surface could be rough and necrotic,while the surface of benign tumors was smooth and complete,with no roughness and necrosis,33 cases( 68. 75%) suffered from lumen stenosis which was more than 50%. Conclusion The incidence of primary tracheal tumors is low,the clinical symptoms and signs are lack of specificity,and the main pathological types are adenoid cystic carcinoma and squamous cell carcinoma; the surface characteristics and involvement ranges of benign and malignant tumors are different,which can be differentiated by microscopy. In brief,bronchoscopy is an important method for diagnosis.
Objective To summarize clinical characteristics and endoscopic features of various types of primary tracheal tumors,so as to guide clinical diagnosis and treatment. Methods Clinical,endoscopic and pathological data of patients with primary tracheal tumors who underwent bronchoscopy from January 2009 to December 2015 in Endoscopy Department of Tumor Hospital of Chinese Academy of Medical Sciences were collected and retrospectively analyzed. Results There were 48 cases of primary tracheal tumor. Adenoid cystic carcinoma and squamous cell carcinoma were the most common pathological types,accounting for 64. 6%. The main clinical manifestations were shortness of breath,cough,blood in sputum and so on,and wheezing sound appeared in most patients; the sensitivity of CT examination was 93. 8%,and the diagnostic rate of biopsy under microscope was 92. 9%. Endoscopic tracheal tumors could occur in all parts of trachea with uneven lengths and various forms. Malignant tumors could be protuberant,with pattern of polypoid and cauliflower,moreover,the surface could be rough and necrotic,while the surface of benign tumors was smooth and complete,with no roughness and necrosis,33 cases( 68. 75%) suffered from lumen stenosis which was more than 50%. Conclusion The incidence of primary tracheal tumors is low,the clinical symptoms and signs are lack of specificity,and the main pathological types are adenoid cystic carcinoma and squamous cell carcinoma; the surface characteristics and involvement ranges of benign and malignant tumors are different,which can be differentiated by microscopy. In brief,bronchoscopy is an important method for diagnosis.
引文
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[7]杨峰,罗为展,李时悦,等.原发性气管恶性肿瘤48例临床分析[J].中国医药导报,2015,12(31):82-84,92.
[8] Begnauda,Connettje,Harwoodem,et al. Measuring Central Airway Obstruction:What Do Bronchoscopists Do?[J]. Annam Thoracsoc,2015,12(1):85-90.
[9] Gaissert HA,Grillo HC,Shadmehr MB,et al. Long-term survival after resection of primary adenoid cystic and squamous cell carcinoma of the trachea and carina[J]. Ann Thorac Surg,2004.
[10] Sherani K, Vakil A, Dodhia C, et al. Malignant tracheal tumors:a review of current diagnostic and management strategies[J]. curropin pulmmed,2015,21(4):322-326.
[11]丁银峰,陈龙,黄海东,等,支气管镜介入治疗原发性气管肿瘤的临床分析[J].中华结核和呼吸杂志,2017,6(40):435-439.
[2] Guptd,Singhi,Sakthivelp. Adenoidcystic carcinoma of trachea:a diagnostic and therapeutich challenge[J]. Indian Jotolaryngol Head Necksurg,2016,68(1):94-96.
[3] Junkerk. Pathology of tracheal tumors[J]. Thorac Surgclin,2014,24(1):7-11.
[4] Brannd-saberibe,Sch-fert. Trachea:anatomy and physiology[J]. Thorac Surg Clin,2014,24(1):1-5.
[5] Urdaneta AI,Yu JB,Wilson LD. Population based cancer registry analysis of primary tracheal carcinoma[J]. Am J Clin Oncol,2011,34(1):32-37.
[6]陈力,詹成,金玉麟,等,原发性气管及主支气管恶性肿瘤的临床诊治[J].中国临床医学,2017,8(24):591-594.
[7]杨峰,罗为展,李时悦,等.原发性气管恶性肿瘤48例临床分析[J].中国医药导报,2015,12(31):82-84,92.
[8] Begnauda,Connettje,Harwoodem,et al. Measuring Central Airway Obstruction:What Do Bronchoscopists Do?[J]. Annam Thoracsoc,2015,12(1):85-90.
[9] Gaissert HA,Grillo HC,Shadmehr MB,et al. Long-term survival after resection of primary adenoid cystic and squamous cell carcinoma of the trachea and carina[J]. Ann Thorac Surg,2004.
[10] Sherani K, Vakil A, Dodhia C, et al. Malignant tracheal tumors:a review of current diagnostic and management strategies[J]. curropin pulmmed,2015,21(4):322-326.
[11]丁银峰,陈龙,黄海东,等,支气管镜介入治疗原发性气管肿瘤的临床分析[J].中华结核和呼吸杂志,2017,6(40):435-439.