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目的探讨原发性气管肿瘤外科治疗特点及预后,提高其诊治水平。方法回顾性分析1982年2月至2009年8月中南大学湘雅医院和湖南省肿瘤医院收治的38例原发性气管肿瘤患者的临床资料,其中男24例,女14例;年龄7～65岁。良性病变2例,腺样囊性癌13例,鳞癌11例,粘液表皮样癌5例,腺癌4例,其他组织类型3例。1例行开胸探查术,33例行肿瘤切除术和气道重建术,根据肿瘤生长特征行气管环形切除术+端端吻合术或气管楔形切除术,1例在纤维支气管镜下行乳头状瘤切除术;另3例未行手术治疗。采用Kaplan-Meier法计算生存率,采用log-rank法比较不同气管肿瘤组织类型及行不同术式患者的生存率。结果行开胸探查术1例患者术后第3d死于呼吸衰竭,围术期病死率2.94%(1/34),余33例术后康复出院。术后早期并发症发生率35.29%(12/34),其中肺部感染6例、肺不张4例及声音嘶哑2例。随访6个月～15年,随访率97.29%(36/37)。3例未手术患者均在出院后6个月内死亡。33例患者术后1年、5年和10年生存率分别为88%[95%CI(0.77,0.99)]、47%[95%CI(0.29,0.66)]和41%[95%CI(0.21,0.61)]。腺样囊性癌及粘液表皮样癌术后生存率明显高于鳞癌及其他组织类型(χ2=17.581,P=0.001)。患者行气管楔形切除术与环形切除术后5年生存率分别为63%[95%CI(0.34,0.91)]和77%[95%CI(0.44,0.99)],其差异无统计学意义(χ2=0.021,P=0.886)。结论原发性气管肿瘤首选手术治疗,术后远期生存率与肿瘤组织类型有关。
Objective To investigate the characteristics and prognosis of surgical treatment of primary tracheal tumor and to improve its diagnosis and treatment. Methods The clinical data of 38 patients with primary tracheal tumor admitted from Xiangya Hospital of Central South University and Hunan Cancer Hospital from February 1982 to August 2009 were retrospectively analyzed. There were 24 males and 14 females, aged from 7 to 65 year old. Benign lesions in 2 cases, adenoid cystic carcinoma in 13 cases, squamous cell carcinoma in 11 cases, mucoepidermoid carcinoma in 5 cases, adenocarcinoma in 4 cases and other tissue types in 3 cases. One patients underwent thoracotomy and 33 underwent tumor resection and airway reconstruction. According to the characteristics of tumor growth, tracheotomy plus end-to-end anastomosis or tracheal wedge resection were performed. One patient underwent resection of the papilloma by bronchofibroscopy Surgery; the other 3 cases did not undergo surgical treatment. The Kaplan-Meier method was used to calculate the survival rate. The log-rank method was used to compare the different types of tracheal tumor and the survival rates of patients undergoing different surgical procedures. Results Thoracotomy 1 case of patients died of respiratory failure on the 3rd postoperative, perioperative mortality was 2.94% (1/34), more than 33 cases were discharged after surgery. The incidence of early postoperative complications was 35.29% (12/34), including 6 cases of pulmonary infection, 4 cases of atelectasis and 2 cases of hoarseness. All cases were followed up for 6 months to 15 years. The follow-up rate was 97.29% (36/37). Three patients who did not surgery died within 6 months after discharge. The 1-year, 5-year and 10-year survival rates of the 33 patients were 88% [95% CI 0.77,0.99], 47% [95% CI 0.29,0.66], and 41% 95% CI 0.21, 0.61)]. The postoperative survival rates of adenoid cystic carcinoma and mucoepidermoid carcinoma were significantly higher than those of squamous cell carcinoma and other tissues (χ2 = 17.581, P = 0.001). The 5-year survival rates were 63% [95% CI (0.34, 0.91)] and 77% [95% CI (0.44, 0.99)], respectively, for patients treated with wedge resection and circumcision, with no significant difference χ2 = 0.021, P = 0.886). Conclusion The primary surgical treatment of primary tracheal tumor, postoperative long-term survival rate and tumor type.