Department of Otorhinolaryngology, Head and Neck Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, China,
Eur Arch Otorhinolaryngol. 2014 Feb;271(2):225-35. doi: 10.1007/s00405-013-2429-9. Epub 2013 Mar 20.
To explore clinical manifestation and therapies of primary malignant tumors of the cervical trachea, we retrospectively reviewed 31 patients with primary cervical tracheal malignant tumors diagnosed in the last 15 years by means of clinical manifestation, fiberoptic endoscopy, CT scanning and histopathological examinations. All of them were hospitalized and treated at the Second Xiangya Hospital, Central South University. Of them, 4 underwent emergent tracheotomy under local anesthesia, 9 were inserted with a laryngeal mask airway, 18 underwent tumorectomy under general anesthesia with endotracheal intubation, and of them 11 had tracheotomy during surgery. Of those 31 patients, tracheal malignant tumors in 9 cases were resected via laryngeal and retrograde tracheal incisions under endoscope; the tumors in 13 cases were excised via sleeve trachea resection and end-to-end anastomosis; those in 8 were removed by tracheofissure, and the tumor in 1 case was not excised surgically. Among the 30 resected patients, 20 patients received both radiotherapy and chemotherapy; 6 received radiotherapy only, and 4 did not receive any adjuvant therapies. During follow-up between 2 and 11 years, among 31 patients, there was no recurrence in 24 cases. Among the 7 deceased patients, 1 displayed multiple tracheal chondrosarcoma, 4 displayed adenoid cystic carcinoma, and 2 displayed squamous cell carcinoma. Emergency lower tracheotomy is necessary only when patients with tracheal, malignant tumors are in a critical condition. Sleeve trachea resection is the optimal therapy for tracheal malignant tumors. However, in the treatment of tracheal malignant tumors adjacent to the larynx or the involved trachea is over 6 cm in length, other surgeries shall be performed. Postoperative adjuvant radiotherapy and chemotherapy can achieve the same therapeutic effect as sleeve trachea resection.
为了探讨原发性颈段气管恶性肿瘤的临床表现和治疗方法，我们回顾性分析了 15 年来在中南大学湘雅二医院经纤维支气管镜、CT 扫描和组织病理学检查确诊的 31 例原发性颈段气管恶性肿瘤患者的临床资料。所有患者均住院治疗。其中 4 例行局部麻醉下紧急气管切开术，9 例行喉罩通气，18 例行全身麻醉下气管内插管肿瘤切除术，其中 11 例在术中行气管切开术。31 例患者中，9 例经内镜下喉及逆行气管切开切除气管恶性肿瘤；13 例行袖状气管切除术端端吻合术；8 例行气管裂开术，1 例未手术切除肿瘤。30 例切除患者中，20 例接受放化疗，6 例单纯放疗，4 例未接受辅助治疗。2 ～ 11 年随访期间，31 例患者中无复发 24 例，死亡 7 例，其中多灶性气管软骨肉瘤 1 例，腺样囊性癌 4 例，鳞癌 2 例。气管恶性肿瘤患者只有在危急情况下才需要紧急行低位气管切开术。袖状气管切除术是治疗气管恶性肿瘤的最佳方法。但对于累及喉或长度超过 6cm 的气管的气管恶性肿瘤，应选择其他手术方式。术后辅助放化疗可达到与袖状气管切除术相同的治疗效果。
