原发性气管肿瘤诊治经验临床病例系列研究

发布时间：2018-04-16 20:27

本文选题：原发性气管肿瘤 + 临床特点　；参考：《浙江大学》2015年博士论文

【摘要】：目的：原发性气管肿瘤是一种呼吸系统肿瘤性疾病。该病临床少见,恶性多见,起病隐匿,诊断困难,治疗多样,预后不良。本研究的目的是回顾性分析原发性气管肿瘤患者的病例资料,探讨该病的临床特点,实验室检验,影像学检查,病理特点,手术、介入、放疗和化疗等诊治方法,以及预后等情况。方法：收集自2010年1月至2015年3月期间就诊于浙江大学医学院附属第一医院,并最终病理确诊为“原发性气管肿瘤”的病例资料。分析讨论了上述患者的基本情况(性别、年龄等)、症状与体征、检验与检查(血气分析、肺功能检查、影像学检查和纤维支气管镜检查等)、病理情况、误诊情况、治疗方法(手术、介入、放疗和化疗等)以及转归情况等。在数据库中检索1990年1月至2015年3月期间发表的“原发性气管肿瘤”相关的文献资料,整理并分析该病的临床特点、诊治经验等相关研究进展。结果：检索共得到22例原发性气管肿瘤患者的病例资料,其中男性15例,女性7例(男性68.2%),发病年龄30-86岁(中位61.5岁),有吸烟史者13例(59.1%)。肿瘤位于气管上段31.8%,中段18.2%,下段50%。病理结果提示13例为恶性(鳞癌7例,腺样囊性癌5例,类癌1例),9例为良性(平滑肌瘤3例,错构瘤2例,唾液腺腺瘤1例,乳头状瘤1例,炎性息肉2例)。治疗方法中,手术切除者5例,纤维支气管镜下气管内介入治疗者17例。随访时间1.7月至60.2月不等,中位随访时间22.6月。13例恶性肿瘤患者中,1例死亡,另有2例治疗后随访发现新发转移。结论：原发性气管肿瘤相对少见,起病隐匿,病程较长,临床症状与体征无明显特异性,血气分析、肺功能检查以及胸部X片等早期常无明显异常,因而误诊、漏诊率较高。诊断主要依靠纤维支气管镜及胸部CT检查。外科手术对于早期患者疗效较佳,纤维支气管镜下气管内介入治疗辅以化疗、放疗对于晚期患者具有重要意义。
[Abstract]:Objective: primary trachea tumor is a neoplastic disease of respiratory system.The disease is rare, malignant, occult, difficult to diagnose, diverse in treatment and poor in prognosis.The purpose of this study was to retrospectively analyze the data of patients with primary tracheal neoplasms, and to explore the clinical features, laboratory tests, imaging examination, pathological features, surgical treatment, interventional therapy, radiotherapy and chemotherapy, etc.And prognosis.Methods: data were collected from January 2010 to March 2015 in the first affiliated Hospital of Zhejiang University Medical College, and were pathologically diagnosed as "primary tracheal neoplasms".The basic conditions (sex, age, etc.), symptoms and signs, examination and examination (blood gas analysis, pulmonary function examination, imaging examination and fiberoptic bronchoscopy, etc.), pathology, misdiagnosis were analyzed and discussed.Methods of treatment (surgery, interventional, radiotherapy and chemotherapy) and outcome.To search the literature about "primary tracheal neoplasms" published from January 1990 to March 2015, and analyze the clinical characteristics, diagnosis and treatment experience of the disease.Results: a total of 22 patients with primary tracheal neoplasms were collected, including 15 males and 7 females (68.2% male). The onset age was 30-86 years old (median 61.5 years old, 13 cases with smoking history 59.1%).The tumor is located in the upper part of the trachea, in the middle segment, in the middle segment, and in the lower segment.The pathological results showed that 13 cases were malignant (7 cases of squamous cell carcinoma, 5 cases of adenoid cystic carcinoma, 1 case of carcinoid carcinoma) and 9 cases of benign (leiomyoma 3 cases, hamartoma 2 cases, salivary gland adenoma 1 case, papilloma 1 case, inflammatory polyp 2 cases).Among them, 5 cases were resected and 17 cases were treated by fiberoptic bronchoscopy.The follow-up time ranged from 1.7 months to 60.2 months. The median follow-up time was 22.6 months. One patient died out of 13 patients with malignant tumor.Conclusion: primary tracheal neoplasms are relatively rare, occult, long course of disease, no obvious specificity of clinical symptoms and signs, blood gas analysis, pulmonary function examination and chest X ray, so the misdiagnosis rate is high.The diagnosis mainly depends on fiberoptic bronchoscopy and chest CT examination.Surgical treatment is effective for early stage patients. Fiberoptic bronchoscopic intratracheal interventional therapy combined with chemotherapy is of great significance for late stage patients.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R734.1

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