Fischer S, Kruger M, McRae K, Merchant N, Tsao M S, Keshavjee S
Department of Surgery, The Toronto General Hospital, University of Toronto, Ontario, Canada.
Ann Thorac Surg. 2001 Jan;71(1):386-93. doi: 10.1016/s0003-4975(00)02251-7.
Bronchial carcinoid tumors account for approximately 2% of all lung tumors. Although they were considered benign lesions, they are now categorized malignant, occasionally with poor prognosis. The clinical symptoms can be highly variable and are often present for many years before diagnosis. Whereas some carcinoids are entirely asymptomatic, others are accompanied by carcinoid or paraneoplastic syndromes.
We describe the multidisciplinary management of a 34-year-old female patient with a massive actively secreting bronchial carcinoid tumor of the right lung. Furthermore, we provide a review of the literature regarding the operative treatment and the perioperative management of pulmonary carcinoid tumors with respect to surgical, anesthetic, radiologic, and pathologic considerations.
In the reported case, the first symptoms were chronic watery diarrhea, skin flushing, progressive shortness of breath, and increasing right shoulder pain. When the patient initially presented at our institution, the tumor had already reached an enormous size and it involved the right and left atrium as well as the atrial septum. Using an evidence-based, multidisciplinary approach the patient was treated successfully with extended surgical resection.
Carcinoid tumors are potentially curable even if they reach a significant size and thus an aggressive strategy is warranted. The management of such cases requires careful investigation, planning, and treatment with collaborative expertise provided by a multidisciplinary team. We demonstrated that this approach can lead to a favorable outcome in what first appeared to be a formidable and unresectable tumor.
支气管类癌肿瘤约占所有肺部肿瘤的2%。尽管它们曾被认为是良性病变，但现在被归类为恶性肿瘤，偶尔预后较差。临床症状变化很大，在诊断前往往已存在多年。有些类癌完全没有症状，而其他类癌则伴有类癌综合征或副肿瘤综合征。
我们描述了一名34岁女性患者的多学科管理情况，该患者患有右肺巨大且活跃分泌的支气管类癌肿瘤。此外，我们就手术、麻醉、放射学和病理学方面的考虑，对有关肺类癌肿瘤手术治疗和围手术期管理的文献进行了综述。
在该报道病例中，最初症状为慢性水样腹泻、皮肤潮红、进行性气短和右肩疼痛加剧。当患者首次到我院就诊时，肿瘤已长得非常大，累及右心房、左心房以及房间隔。采用基于循证的多学科方法，患者通过扩大手术切除获得成功治疗。
即使类癌肿瘤长得很大，它们仍有可能治愈，因此需要采取积极的策略。此类病例的管理需要仔细的检查、规划，并由多学科团队提供协作性专业知识进行治疗。我们证明，这种方法可以在最初看似棘手且无法切除的肿瘤治疗中取得良好效果。
