22例原发性气管肿瘤的诊断与外科治疗
张哲1何宝亮1唐国建1尹志伊1王伦清1彭忠民2陈景寒2
（1.青岛市市立医院胸外科,山东青岛266071；2.山东省立医院胸外科，济南250021）
摘要：目的总结22例原发性气管肿瘤手术治疗的临床经验，以提高手术疗效。方法22例原发性气管肿瘤患者，其中良性肿瘤4例,恶性肿瘤18例。行气管对端吻合14例,隆凸重建4例,纤维支气管镜下摘除肿瘤1例,局部搔刮2例,气管修补1例。气管切除长度2.0～5.2cm，平均3.8cm。结果22例中确诊前有17例在门诊误诊，误诊率77.3%，大多数患者被误诊为支气管哮喘。术后3
0d内死亡1例，死于急性呼吸衰竭。发生并发症7例（318%），分别为肺部感染4例，吻合口
瘘1例，乳糜胸2例；远期并发症吻合口狭窄3例，经再次手术治疗，狭窄改善。随访20例，随访时间1个月～8年。4例良性肿瘤患者在随访期间均无瘤生存；16例恶性肿瘤患者术后随访满5年以上生存6例,因肿瘤脑、肝和骨远处转移死亡3例。结论手术切除是治疗气管肿瘤最有效的方法,气管节段切除是治疗气管恶性肿瘤的主要术式,良性肿瘤可以考虑保守术式,降低手术并发症是取得良好手术疗效的关键,掌握气管肿瘤的临床特点、提高对该病的认识是减少误诊的有效手段。
关键词：气管肿瘤;外科手术;预后
中图分类号：R655.3文献标识码：A文章编号：1007-4848（2009）01-0019-03TheDiagnosisandSurgicalTreatmentof22PatientswithPrimaryTrachealTumorsZHANGZhe1,HEBaoliang1,TANGGuojian1,YINZhiyi1,WANGLunqing1,PENGZhongmin2,CHENJinghan2.（1.DepartmentofThoracicSurgery,QingdaoMunicipalHospital,Qingdao266071,Shandong,P.R.China;2.DepartmentofThoracicSurgery,ShandongProvincialHospital,Jinan250021,P.R.China）Correspondingauthor:ZHANGZhe,E-mail:doctorzhangzhe@yahoo.com.cn
Abstract:ObjectiveTosummarizetheclinicalexperiencesintreatingprimarytrachealtumorsbysurgery,soastoimprovetheresultsofsurgicaltreatment.MethodsTheclinicaldataconcerning22surgicallytreatedpatientswereretrospectivelyanalyzed.Fourpatientstumorwerebenignandeighteencases’stumorwasmalignant.Trachealresectionsandendtoendanastomosiswereperformedin14cases,carinalresectionwasperformedin4cases,lateraltrachealwallresectionwasperformedin1case,localscrapewereperformedin2cases,tumorwasresectedtransfiberopticbronchoscopyin1case.Trachealresectablelengthwasfrom2.0cmto5.2cm，andtheaverageresectablelengthwas3.8cminoperation.Results17caseshadbeenmisdiagnosised（77.3%）inoutpatientdepartment.Itwaseasytobemisdiagnosisedasasthma.Onecasediedofrespiratoryfailureafteroperationin30days.Thecomplicationratewas31.8%,complicationsconsistofpneumoniain4cases,anastomosisleakagein1caseandchylothoraxin2cases.Anastomosisstenosiswasfoundin3cases,thesyndromeswereimprovedaftertreatment.Twentycaseswer
efollowedupfrom1monthto8years.Fourcaseswithbenigntumorswerestillalive.Among16caseswithmalignanttumors,6caseshadsurvivedmorethan5years，3casesdiedofbrain,liver,bonemetastasisofmalignanttumors.ConclusionSurgicalresectionisthemosteffectivetreatmentoftrachealtumors.Trachealresectionandreconstructionisthemainchoiceofprimarytrachealtumorstreatment.Benigntumorscanberesectedconservatively.Thereductionsofoperativecomplicationsarethekeypointsofgoodsurgicalresults.Toknowthecharacteristicofprimarytrachealtumorswellcanreducethemisdiagnosisrate.
Keywords:Trachealneoplasms;Surgicalprocedures;Prognosis
