体外循环下切除原发性气管恶性肿瘤的围手术期处理

目的总结体外循环下切除原发性气管恶性肿瘤围手术期的处理经验。方法自1999年12月至2003年8月,6例原发性气管恶性肿瘤患者在体外循环下行肿瘤切除术。2例患者经右股动、静脉插管行急诊手术,4例患者开胸经右心房和升主动脉插管建立体外循环。3例患者行气管环形切除、气管断端行端端吻合;2例患者行气管下段和隆突切除、隆突重建;1例患者行肿瘤剔除术。术前和术后给予雾化吸人,协助咳痰,保持呼吸道通畅。结果术后呼吸困难均有明显好转,呼吸机辅助呼吸10h～7d,全组无手术死亡。结论对于气管严重梗阻的原发性气管恶性肿瘤患者,体外循环下行肿瘤切除是有效的治疗方法,术前和术后保持呼吸道通畅有利于术后恢复。     

气管隆突部肿瘤的手术体会(附14例报告)

目的:探讨气管隆突部肿瘤的手术方法及早期诊断.方法:总结本院1989年1月至2002年12月14例气管隆突部肿瘤或中心性肺癌累及隆突的手术方法、病理及预后.其中良性病变3例,低度恶性肿瘤4例,余7例为腺癌和鳞癌.一侧全肺加隆突切除2例,右肺上叶加隆突切除重建2例,不切肺叶单行隆突切除重建8例,姑息切除1例,手术探查1例.结果:所有病例手术过程顺利.1例肿瘤累及食管,术后发生吻合口瘘,后治愈.2例术后发生吻合口肉芽肿而狭窄,经微波治疗治愈.余无严重并发症.结论:绝大部分病例可单纯切除气管下段及两侧主支气管近端,将病变切除而不切除肺叶.少数病例可连同一侧的肺上叶切除而不行全肺切除.只有较晚期的中心型肺癌同时累及隆突及中间支气管才行全肺加隆突切除,而此种手术不必切断对侧支气管的外侧壁.     

气管隆凸主支气管肿瘤的外科治疗

目的 总结气管、隆凸主支气管肿瘤手术治疗经验,探讨合理的手术方法及治疗措施。方法 回顾性分析我院在1996年1月至2004年6月期间,手术治疗的27例气管、隆凸主支气管肿瘤患者的临床资料。27例中,鳞癌15例,腺癌3例,其余9例为良性腺瘤、腺样囊腺癌和类癌。结果 气管肿瘤切除＋端端吻合8例;全肺隆凸切除＋气管与主支气管端端吻合9例（右6例,左3例）;右上肺隆凸袖式切除重建术2例;隆凸切除重建术3例;气管肿瘤及气管壁部分切除5例,其中体外循环辅助下手术2例。术后早期死亡3例,其中2例死于多器官衰竭,1例系因胸腔感染、出血死亡。半年以上随访24例,无死亡,无外科并发症。结论 隆凸及气管手术比较复杂,难度大,应选择合理的术式及麻醉方法,必要时应用体外循环辅助,可以取得满意疗效。     

气管隆突主支气管切除成形手术治疗中心型肺癌

目的　总结 1981年 7月～ 1995年 7月 18例气管隆突、主支气管切除成形手术治疗中心型肺癌的经验。方法　主支气管袖状切除对端吻合术 8例 ,全隆突切除重建 1例 ,左全肺切除部分隆突切除重建 1例 ,右上肺叶切除部分隆突切除重建 4例、支气管楔形肺叶切除 4例。结果　术后 2 1天死亡 1例 ,系吻合口肉芽肿形成 ,激光治疗后死于肺动脉破裂出血。术后一年生存率 82 .4% ( 14 /17) ,三年生存率 47.1% ( 8/17) ,五年生存率 3 5 .3 % ( 5 /17)。结论　气管隆突主支气管切除成形手术提高了中心型肺癌的手术切除率 ,并取得满意的治疗效果。     

隆突切除重建术的临床应用27例报道

目的:总结隆凸切除重建术治疗隆突、主支气管肿瘤及中心型支气管肺癌的经验,探讨合理的手术方法及治疗措施。方法:27例患者行单纯隆突切除重建4例,右肺上叶切除及隆突切除重建19例,右全肺切除及隆突切除重建2例,左肺上叶切除及隆突切除重建1例,左全肺切除及隆突切除重建1例。结果:全组病例无围手术期死亡,无支气管吻合口瘘。常见并发症为心律失常、肺部感染、肺不张和呼吸功能不全。隆突、主支气管肿瘤患者术后无瘤生存2~11年。支气管肺癌患者术后3年生存率68.8%,5年生存率36.4%,有1例生存>10年。结论:通过合理的麻醉插管方法,正确的气管吻合技术,良好的术后呼吸道管理,气管隆凸切除重建术可以取得满意的疗效。     

气管隆突主支气管作成形手术治疗中心型肺癌

目的 总结１９８１年７月￣１９９５年７月１８例气管隆突、主支气管切除成形手术治疗中心型肺癌的经验。方法 主支气管袖状切除对端吻合术８例,全隆突切除重建１例,左全肺切除部分隆突切除重建１例,右上肺叶切除部分隆突切除重建４例、支气管楔形肺叶切除４例。结果 术后２１天死亡１例,系吻合口肉芽肿形成,激光治疗后死于肺动脉破裂出血。术后一年生存率８２．４％（１４／１７）,三年生存率４７．１％（８／１７）,五年     

气管支气管成形术治疗中心型肺癌的探讨

作者采用多种气管支气管成形切除术治疗段支气管以上中心型肺癌３９例。术式包括气管或隆突袖状切除３例，全肺及半隆突切除、主支气管楔形切除、上叶支气管－主支气管－气管侧壁大弧形切除、支气管楔形或袖状切除３６例。术后５年生存率４２．１％（８／１９）。作者对术式和病例选择、手术要点、并发症防治等问题作了探讨。     

低度恶性型肺黏液表皮样癌5例分析

目的:分析低度恶性肺黏液表皮样癌的诊断、发病年龄、影像学特点、临床特点、外科治疗、随访及预后情况.方法:回顾总结5例手术切除的原发性肺黏液表皮样癌,行肺叶切除术3例,肺叶切除加支气管袖状切除1例,肺楔形切除1例,并分析其临床特征.结果:5例术前经影像学检查均确诊为恶性肿瘤,3例中央型术前行纤支镜检查,其中1例考虑肺黏液细胞癌,1例查出癌细胞,1例未查出癌细胞.4例完全切除病例均未发现淋巴结转移.术后随访1、3、5年生存率均为100%.结论:低度恶性肺黏液表皮样癌经彻底手术切除可获治愈.     

原发性支气管腺样囊性癌的诊断和治疗

目的 探讨原发性支气管腺样囊性癌的临床、病理特征和治疗原则。方法 1980年1月～1997年5月手术治疗8例原发性支气管腺样囊性癌,均经手术和病理证实。结果 原发性支气管腺样囊性癌占同期原发性肺部恶性肿瘤的0.48％(8/1676);男性5例,女性3例;中心型6例,周围型2例;除1例肿瘤固定不能切除外,余7例均行手术切除,且其中4例存在癌残留。3年生存率为83.3％(5/6),5年生存率为60％(3/5)。结论 原发性支气管腺样囊性癌是一种罕见的低度恶性肿瘤,好发于主、叶支气管,X线表现与肺癌不易区别,纤维支气管镜检查最重要。目前认为手术切除是腺样囊性癌最有效的治疗方法,即便是姑息性切除,术后也能生存多年。     

气管、支气管成形术治疗肺部肿瘤

本文报告1978年至1986年9月气管支气管成形术21例。其中气管支气管肺癌18例,粘液表皮样瘤1例,平滑肌瘤1例,错构瘤1例。本组男15例,女6例。年龄24-63岁,平均47.1岁。施行右上叶气管隆突切除重建术2例,左总支气管隆突切除重建术1例,右全肺气管隆突切除4例,右上叶总支气管袖状切除2例,左上叶总支气管袖状切除1例,右上叶袖状切除7例,中叶袖状切除1例,右总支气管下叶袖状切除1例,左总支气管楔形切除1例,气管袖状切除1例。术后8天内死亡3例。本文对手术适应症、麻醉选择、手术体会及术后呼吸道的管理进行了讨论。     

原发性气管主支气管恶性肿瘤的外科治疗(英文)

Objective:The aim of our study was to explore the clinical experience of surgical treatment for primary tracheobronchial malignant tumors.Methods:The clinicopathological data of 18 patients with primary tracheobronchial malignant tumors surgically treated from February 1994 to August 2007 were reviewed retrospectively.The surgical management included sleeve tracheal resection in 8 cases,lower trachea and carina resection with carina reconstruction in 4 cases,local enucleation of the tumor in 4 cases,left or...     

32例气管肿瘤的外科治疗

目的：总结32例气管肿瘤患者外科治疗经验。方法：回顾性分析我科1980～2005年收治的32例气管肿瘤患者外科治疗临床资料。结果：32例气管肿瘤患者中，23例行气管袖状切除端-端吻合术；8例行气管隆凸切除重建术；1例行气管开窗、肿瘤刮除术。术后2例死亡，另有8例发生术后并发症。结论：手术切除是治疗气管肿瘤最有效的方法。气管袖状切除端-端吻合术是治疗气管恶性肿瘤最主要的术式，良性肿瘤可以考虑保守的术式。手术治疗应该兼顾手术的根治性和安全性。     

63例原发性气管肿瘤的诊断与治疗

目的 总结原发性气管肿瘤的临床诊治经验,提高其诊断治疗水平.方法 63例原发性气管肿瘤患者中,61例行手术治疗,2例行激光治疗.61例手术治疗的患者中,行气管袖状切除端-端吻合22例,气管隆嵴切除重建术6例,半隆嵴切除重建6例,颈段气管肿瘤及垂直半喉切除+胸锁乳突肌瓣喉室气管缺损重建术2例,气管肿瘤局部切除17例,气管切除造口术4例,颈段气管切除+甲状腺部分切除+食管肌层切除术1例,颈段气管切除+全喉切除+单纯气管切除造口术1例,隆突搔刮术2例.结果 63例患者中,恶性肿瘤42例,良性肿瘤21例.61例手术治疗的患者中,术后出现并发症8例,其中发生气管纵隔胸膜瘘2例,因喉返神经损伤出现声音嘶哑1例,气管狭窄1例,胸膜腔感染1例.围手术期死亡3例.结论 原发性气管肿瘤临床表现不典型,易误诊,气管恶性肿瘤预后不佳.解除气道梗阻是治疗气管肿瘤的主要目的 .

Abstract：

Objective To summarize the experience in diagnosis and treatment of primary tracheal tumors, and to improve the life quality of patients. Methods Sixty-three patients with primary tracheal tumors treated in the First Affiliated Hospital of China Medical University during the past 40 years were included in this study, among them, there were 42 cases of malignant tumors and 21 cases of benign tumors. The 61 patients underwent surgery including tracheal sleeve resection (22), carinal resection and reconstruction (6), semi-carinal resection and reconstruction (6), tracheal resection for tracheal tumors (17) ;tracheostomy (4), tracheal resection, partial resection of the thyroid (goiter) and esophagomyotomy (1), tracheal tumor resection and vertical hemilaryngectomy with reconstruction of laryngeal ventricle and trachea by sternocleidomastoid flap (2), cervical trachea and laryngeal resection (1), and carinal scrape (2). Results Fifty-five patients had an uneventful recovery. Eight patients suffered from postoperative complications, among them 3 patients died postoperatively. Conclusions Primary tracheal tumors often present atypical symptoms, are easily misdiagnosed and with poor prognosis. The main aim of treatment remains to remove the airway obstruction.     

Tracheal carcinoids.

Three cases of carcinoid tumor arising in the trachea are reported and contrasted with carcinoids arising in bronchi and carcinoids in general. Only eleven other documented examples of tracheal carcinoids are found in the English literature. The true prevalence of carcinoids primary in the trachea cannot be accurately determined from the literature because of imprecise nomenclature or because of the failure to distinguish this tumor from carcinoids primary in the bronchus. Presenting symptoms are hemoptysis, dyspnea and wheezing, often persisting for many years before the correct diagnosis is made. The treatment of choice is surgical resection of the involved segment of trachea and primary reconstruction. The prognosis is generally good. The tumor metastasized in one of our three cases and in none of the eleven cases in the English literature.     

胸段食管癌气管、支气管及隆凸浸润早期的CT诊断与术后病理对照研究

 目的 探讨食管癌气管、支气管、隆凸浸润早期的CT诊断和术后病理的相关性，提高术前CT食管癌T4分期的准确性。方法 49例颈段及胸上、中段食管癌患者术前行颈、胸部CT扫描，将CT扫描结果与术后病理对照，分析颈段及胸上中段食管癌气管、支气管及隆凸受侵早期术前CT诊断的敏感性、特异性、准确性及与术后病理相关性。结果 49例中，颈段21例，胸上、中段28例。术前CT显示肿瘤侵及气管、支气管及隆凸35例：颈段18例，术后病理证实14例受侵；胸上、中段17例，术后病理证实14例受侵。术前CT诊断未受侵14例：颈段3例，术后病理证实1例受侵；胸上、中段11例，术后病理证实3例受侵。CT对颈段及胸上、中段食管癌气管、支气管及隆凸浸润早期诊断的敏感性、特异性、准确性分别为93.3 %，33.3 %，76.2 %和82.4 %，72.7 %，78.6 %，术前CT诊断与术后病理对照的列联系数分别为0.52，0.77。结论 术前CT对食管癌气管、支气管及隆凸浸润早期诊断的敏感性、特异性、准确性，胸上、中段高于颈段；与术后病理有一定相关性。术前CT检查对食管癌气管、支气管、隆凸浸润早期的诊断，并不能作为放弃手术治疗的依据。     

Primary malignant tumors of the trachea. A radiologic and clinical study

Fifty-four cases (55 foci) of primary tracheal malignancies were reviewed retrospectively. Radiologic material was available in 32 cases (33 tracheal foci). The most frequent primary malignant tumor of the trachea was squamous cell carcinoma (54.5%), followed by adenoid cystic carcinoma (18%) and adenocarcinoma (9%). The radiologic appearance of the tumors could be divided into intraluminal, wall-thickening, and exophytic forms. Wall-thickening and exophytic forms in this study accounted for 62% of the tumors. This indicates that malignant tumors of the trachea tend to extraluminal invasion. Tomography and computed tomography are the most helpful methods of radiologic examination for tracheal tumors. Bronchoscopy and radiologic examination are complementary procedures. The chief advantage of imaging is the demonstration of tracheal wall thickening and extraluminal changes. Hemoptysis, dyspnea, and cough were the most common symptoms. Four cases (7%) in our series presented as thyroid tumors due to direct extension into the thyroid gland. Fifteen of the 54 cases (28%) were associated with other carcinomas of the head and neck and the lung.