12例支气管腺样囊性癌临床特征及治疗预后分析

目的分析12例支气管腺样囊性癌患者的临床特征、治疗方式及预后情况以提高临床诊治水平。 方法选择2012年2月至2018年2月唐都医院呼吸科确诊并治疗随访的12例支气管腺样囊性癌患者，收集分析其临床特征及治疗方法，随访生存信息情况。 结果12例患者中位年龄53.5岁，女11例，男1例；均无吸烟史，6例既往无任何疾病史；主要症状咳嗽、咳痰、气短，部分有咯血、胸痛；8例发病于主气管中下段，主气管上段2例，右中间段支气管1例，左主支气管1例；胸部CT以结节、占位为主，部分见钙化、肉芽；支气管镜下表现为菜花样、结节样、肉芽样及球形新生物；气促指数2级5例，3级3例，4级4例；1例右肺全切，11例行2种以上的支气管镜下介入治疗，Ⅰ级缓解率、临床有效率、临床受益率均100%；3例无基线及复发转移，余9例以肺、骨转移多见；生存期均大于5个月。 结论气管腺样囊性癌是一种低度恶性、好发于气管中下段、临床易出现气短症状的肿瘤，以肺、骨转移多见，支气管镜可明确病变范围及气道阻塞程度，支气管镜下介入治疗是非手术患者的一种有效选择，生存时间长。

Clinical features,treatment, and prognosis of twelve cases of bronchial adenoid cystic carcinoma

ObjectiveTo analyze the clinical features, treatment, and prognosis of 12 cases of bronchial adenoid cystic carcinoma. MethodsWe collected the clinical features and therapeutic regimens of 12 patients (11 females and 1 male, with the median age of 53.5 years), who were definitely diagnosed as bronchial adenoid cystic carcinoma and treated in the Respiratory Department in our hospital and carefully followed for their survival information from February 2012 to February 2018. A retrospective analysis was then performed with the clinical features, treatment, and prognosis information. ResultsAll the 12 cases had no history of smoking, and 6 of them had no history of any illness. The main symptoms of all the 12 cases were cough, expectoration, and shortness of breath, and some of them had hemoptysis, chest pain or some other symptoms of respiratory system. In 8 cases, cancer arose from the middle-to-lower bronchial segments and in 2 cases, cancer arose from the upper segment of the main trachea (one from the right middle segment of the bronchus and the other one from the left main bronchus). Chest computed tomography (CT) was performed as a reference for primary diagnosis. In the 12 cases, nodules or masses were mainly shown on CT images, and calcification or granulation could also be observed in the tomography images of some cases. Under a bronchoscope, the tumor tissues were manifested as cauliflower-like, nodule-like, granulation-like, globe-like or other-shaped neoplasms. Borg index reached GradeⅡ in 5 cases, Grade Ⅲ in 3 cases, and Grade Ⅳ in 4 cases. Pneumonectomy was performed in the right lungs in one case and the other 11 cases accepted more than two kinds of bronchoscopic interventional therapies. The remission rate at level 1, clinical efficacy, and clinical benefit rate were all calculated as 100%. No baseline or recurrent metastasis was found in 3 cases, and in the other 9 cases, the carcinomas mainly metastasized to the lungs and bones. The survival time of 12 cases was all longer than 5 months. ConclusionBronchial adenoid cystic carcinoma is a kind of low-grade malignant tumor, which mainly arises from the middle-to-lower bronchial segments. And the bronchial adenoid cystic carcinoma commonly metastasizes to the lungs and bones. The patients with bronchial adenoid cystic carcinoma are most likely to manifest as shortness of breath. Bronchoscopy can be used to define the extent of disease and obstructive degrees. Interventional therapy under a bronchoscope is an effective option, which can prognose a longer lifetime for nonoperative patients.