气管原发性肿瘤的外科治疗(附13例报告)

目的:总结气管原发性肿瘤外科治疗经验，探讨治疗效果及影响因素。方法:总结2007年5月-2009年1月收治的13例行外科治疗的气管原发性肿瘤患者临床资料，分析疗效及影响因素。病理学包括腺样囊性癌8例，黏液表皮样癌2例，上皮-肌上皮癌2例，鳞状细胞癌1例。结果:10例气管肿瘤患者经右胸后外侧切口完成手术，其中8例行气管袖状切除加端-端吻合术，1例行袖式右全肺切除加左主支气管-气管端-端吻合术，1例行隆突切除-隆突重建。另有1例经颈部衣领切口、2例经胸骨正中切口完成手术，均为一期切除后重建。鳞状细胞癌患者有1枚淋巴结转移，其余患者淋巴结均为阴性。2例患者术后出现左侧喉返神经麻痹，无其他术后早期并发症发生，术后住院时间平均(9.7±0.5) d。平均随访（6.8±2.1）个月，无肿瘤复发。结论:手术切除是治疗气管原发性肿瘤的有效方法，病理类型及切除范围对患者术后远期生存率有很大影响。

Surgical treatment of primary tracheal neoplasms:a report of 13 cases

OBJECTIVE: To retrospect our surgical results of tracheal primary neoplasms during the recent two years and analyze influence factors on long term survival according to literaturs review. METHODS: Between May, 2007 and January, 2009, 13 patients treated by resection and reconstruction of the trachea or bifurcation for primary tracheal tumors were retrospectively analyzed. RESULTS: 10 patients accepted a right posteriorlateral thoracic incision. Of them, resection and reconstruction of trachea were performed in 8 patients, 1 patient accepted a sleeve right pneumonectomy and trachea-left main bronchus anastomose, 1 patient accepted carinal resection and reconstruction. Among another 3 patients, collar insicion was used in 2 cases, sternotomy was used in 1. Histological findings included adenoid cystic carcinoma (n=8), squamous cell carcinoma (n=1), mucoepidermoid carcinoma (n=2), epithelial-myoepithelial carcinoma (2). Local lymph node metastasis was found in one patient with squamous cell carcinoma. Except for 2 early patients suffered from recurrent nerve paralysis, no other severe postoperative complications happened. Mean postoperative stay time was 9.7 days. No tumor recurrence was found in a mean follow-up of 6.8 month. Six patients were treated by postoperative external beam radiotherapy. CONCLUSIONS: surgical resection is the effective treatment for tracheal primary neoplasm. Pathologic style and complete resection are main influence factors on the long term survival.