原发性气管癌临床特征及误诊探讨

目的　分析原发性气管癌的临床特征,探讨原发性气管癌的误诊原因和提高早期诊断率的方 法。方法　对我院自1987年以来经纤维支气管镜检查、组织病理学诊断的原发性气管癌93例进行回顾性 研究。结果　原发性气管癌早期主要临床表现为咳嗽、咳痰、咯血等。有67例患者胸部X线片表现异常, 但均为由气管内肿瘤引起的继发性改变。89例胸部CT检查异常,其中腔内结节型64例,管壁弥漫浸润 25例。纤维支气管镜检查显示病变在气管下1/3者37例,隆凸者36例,气管中1/3者13例,气管上1/3 者有7例。病理类型鳞癌54例、小细胞未分化癌17例、腺癌10例、腺样囊性癌1例、未定型11例。在纤 维支气管镜检查前误诊率72.07%。结论　原发性气管癌是早期缺乏特异性的临床表现。原发病变难以在 X线胸片上发现。胸部CT可准确反映原发病变的部位和生长方式。纤维支气管镜检查不但能够准确发 现气管内肿瘤的部位、大小、生长方式而且能够活检、刷检取得组织学依据。加强对本病的认识、积极进行 胸部CT检查和纤维支气管镜检查有助于减少误诊。

Analysis of Clinical Character and Inquiry about Misdiagnosis of Primary Tracheal Cancer

Objective To inquiry into clinical character, misdiagnostic cause and method of improving the diagnostic accuracy of Primary tracheal cancer at early stage.Methods The 93 case of Primary tracheal cancer,confirmed by bronchoscope and pathology,were Retrospectively studied.Results The main signs/symptoms of primary tracheal cancer were cough,sputum and hemoptysis et al.Chest radiography showed abnormal manifestation that related to primary tumor in 67 cases.CT imagining manifested that protrusion toward cavities in 64 cases,diffuse thickening of tracheal wall in 29 cases.Bronchoscope found that lesion was located in lower one-third of tracheal in 37 cases,carina in 36 cases,middle one-third of tracheal in 13 cases,upper one-third of tracheal in 7 cases.54 cases had squamous carcinoma,17 cases had small cell carcinoma,10 cases had adenocarcinoma,1 case had adenid cystic carcinoma,11 cases had undifferentiated.Misdiagnostic incidence was 72.07% before bronchoscope was done.Conclusions Primary tracheal cancer lacked specific symptoms/signs at early stage.Primary lesion were not manifested in chest radiography.Growth site and pattern can be identified from CT manifestation.Bronchoscope not only can found the site, size and growth pattern of tumor,but also can biopsy and brush to acquired pathological specimen.Proliferation was the most growth pattern, squamous cell carcinoma was the most frequent histological type.So to improve realization of primary tracheal cancer and to positively practice CT and bronchoscope examination can help increase the accuracy of diagnosis at early stage.