[颈段气管原发性腺样囊性癌的手术治疗]

Huang Wen-Xi, Xu Zhen-Gang, Tang Ping-Zhang, Qi Yong-Fa, Chen Wei-Quan

Department of Head and Neck Surgery, Guangzhou Tumor Hospital, Guangzhou, Guangdong, 510095, PR China.

Ai Zheng. 2004 May;23(5):581-3.

BACKGROUND & OBJECTIVE: There were few reports about surgery for primary adenoid cystic carcinoma of cervical trachea. This study was designed to evaluate the efficacy of surgical resection of a series of 13 patients with primary adenoid cystic carcinoma of cervical trachea.

METHODS

Thirteen patients who underwent surgical resection with biopsy-proven primary adenoid cystic carcinoma of cervical trachea were reviewed retrospectively.

RESULTS

Of 13 patients, 6 patients showed that tracheal invasion were more than 40 mm length, 7 less than 40 mm length. Seven patients showed extratracheal invasion, 2 showed distance metastases, and 1 showed metastases in regional lymph nodes. Nine patients were treated with sleeve resection of trachea with primary anastomosis (average length of 34.8 mm resected), of which 3 underwent laryngeal release and 8 reserved laryngeal function; 2 received laryngectomy with end tracheostomy and 2 received partial tracheal resection and a patch of autologous tissue reconstruction. Of 13 patients, 4 patients were treated with complete resection and 9 with incomplete resection alone or combined by postoperative irradiation. No death occurred during operation. Two tracheal stenoses and 1 laryngeal recurrent nerve palsy after operation were observed. Seven patients died after therapy, of which 6 patients failed to local management, 1 case died of distance metastases. The total 5- and 10-year survival rates were 69.2% (9/13) and 50.0% (5/10), respectively. The 5- and 10-year survival rates were 75.0% (3/4) and 75.0% (3/4) for complete resection group, 55.0% (5/9) and 33.0% (2/6) for incomplete resection group, 83.3% (5/6) and 83.3% (5/6) for non-extratracheal invasion group, 57.1% (4/7) and 0% for extratracheal invasion group (P=0.001).

CONCLUSION

Sleeve resection of trachea with primary reconstruction is the major treatment of the patients suffering from primary cervical tracheal adenoid cystic carcinoma with the long-term survival and function reservation.

背景与目的

关于颈段气管原发性腺样囊性癌手术治疗的报道较少。本研究旨在评估13例颈段气管原发性腺样囊性癌患者手术切除的疗效。

方法

回顾性分析13例行手术切除且经活检证实为颈段气管原发性腺样囊性癌的患者。

结果

13例患者中，6例气管侵犯长度超过40mm，7例小于40mm。7例有气管外侵犯，2例有远处转移，1例有区域淋巴结转移。9例患者行气管袖状切除并一期吻合（平均切除长度34.8mm），其中3例行喉松解术，8例保留喉功能；2例行喉切除术并气管造口术，2例行部分气管切除及自体组织补片重建。13例患者中，4例接受根治性切除，9例接受单纯不完全切除或联合术后放疗。术中无死亡病例。术后观察到2例气管狭窄和1例喉返神经麻痹。7例患者治疗后死亡，其中6例局部治疗失败，1例死于远处转移。5年和10年总生存率分别为69.2%（9/13）和50.0%（5/10）。根治性切除组5年和10年生存率分别为75.0%（3/4）和75.0%（3/4），不完全切除组为55.0%（5/9）和33.0%（2/6），无气管外侵犯组为83.3%（5/6）和83.3%（5/6），气管外侵犯组为57.1%（4/7）和0%（P = 0.001）。