原发性气管肿瘤的诊断及外科治疗

原发性气管肿瘤约占呼吸系统肿瘤1%,约有20余种类型.但由于气管本身解剖及功能的特殊性,气管肿瘤早期诊断困难,极易引起误诊,误诊率可达83.3%,有误诊长达10年的报道.减少误诊、防止漏诊、提高早期诊断率的关键措施在于提高对原发气管肿瘤的认识,主要诊断手段包括胸部CT及纤维支气管镜检查.外科治疗是气管肿瘤治疗的重要组成部分,主要包括:气管开窗肿物摘除术,气管局部切除缝合术,气管环行切除对端吻合术,隆突切除吻合术.麻醉和呼吸道管理是气管外科手术成功的重要保证,要根据肿瘤的不同情况采用不同的麻醉方式,强调麻醉医师参与术前讨论的重要性.外科术后的并发症主要包括:吻合口瘘,吻合口大血管瘘,吻合口狭窄及肉芽肿形成,肺部感染及肺不张.

Abstract：

Primary airway tumors are accounted about 1 % of respiratory tumors and have above 20 types. However, due to particularity of the anatomy and function of airway, early diagnosis of the primary air tumors is difficult and the rate of misdiagnosis can reach 83.3 %. To reduce the rate of misdiagnosis, the key measurements of diagnosis are recognization of primary airway tumors, and the main methods include chest computed tomography (CT) and fiberoptic bronchoscopy examination. Surgical treatment is an important part,it includes tumor excision by airway fenestration, the part excision of airway and suture, the resection of airway tumor by its margin and anastomosis, and carinal resection and anastomosis. Anesthesia and the management of respiratory airway are important guarantees for the successful operation. According to the difference of the tumors, the suitable method of anesthesia should be choiced. It is emphasized for anesthesiologist to participate in the preoperative discussion. The postoperative complications include the anastomotic fistula, the anastomotic fistula communication with large vessel, the anastomotic stenosis and granuloma formation, and the pulmonary infection and atelectasis.

Diagnosis and surgical treatment of primary airway tumors

Primary airway tumors are accounted about 1 % of respiratory tumors and have above 20 types. However, due to particularity of the anatomy and function of airway, early diagnosis of the primary air tumors is difficult and the rate of misdiagnosis can reach 83.3 %. To reduce the rate of misdiagnosis, the key measurements of diagnosis are recognization of primary airway tumors, and the main methods include chest computed tomography (CT) and fiberoptic bronchoscopy examination. Surgical treatment is an important part,it includes tumor excision by airway fenestration, the part excision of airway and suture, the resection of airway tumor by its margin and anastomosis, and carinal resection and anastomosis. Anesthesia and the management of respiratory airway are important guarantees for the successful operation. According to the difference of the tumors, the suitable method of anesthesia should be choiced. It is emphasized for anesthesiologist to participate in the preoperative discussion. The postoperative complications include the anastomotic fistula, the anastomotic fistula communication with large vessel, the anastomotic stenosis and granuloma formation, and the pulmonary infection and atelectasis.