Hurt R, Bates M
Thorax. 1984 Aug;39(8):617-23. doi: 10.1136/thx.39.8.617.
The term adenoma of the bronchus is discussed, and 79 cases of bronchial carcinoid seen from 1951 to 1983 are reviewed. The symptoms, radiological findings, and bronchoscopic appearances are described. There was no case of the carcinoid syndrome. In no case did haemorrhage cause any serious problem after biopsy at rigid bronchoscopy. In three patients the tumour was reported to be an oat cell carcinoma-in two on the basis of material obtained at fibreoptic bronchoscopy. Resection was by pneumonectomy in 10 cases, lobectomy in 52, segmentectomy in six, a bronchoplastic procedure without resection of lung in seven cases, enucleation in two, and a wedge resection in one case. There was one case of atypical carcinoid which was found at operation to be unresectable. A 5-30 year follow up in 57 cases revealed a recurrence of tumour in two cases, nine and 16 years after lung resection. No recurrence occurred in the nine cases treated by conservative bronchial resection with conservation of lung tissue. An actuarially assessed life table analysis shows survival rates of 94% after 10 years, 80% after 15 years, and 64% after 25 years without recurrence. The similarity of carcinoid to oat cell carcinoma is noted and the serious clinical implications of this are analysed, especially in view of the increasing use of fibreoptic bronchoscopy. The malignant potential of carcinoid and the extent of pulmonary resection is discussed. It is concluded that a carcinoid tumour of the lung has only slight malignant potential and that it may be treated by bronchotomy or sleeve resection of the bronchus in suitable cases. If serious infective changes have occurred in the lung distal to the tumour or if the tumour has extended into the lung parenchyma (88% of cases in this series) lung resection will be necessary. The follow up period should be for at least 25 years, in view of the incidence of late recurrence.
本文讨论了支气管腺瘤这一术语，并回顾了1951年至1983年间所见的79例支气管类癌病例。描述了其症状、放射学表现及支气管镜检查外观。无类癌综合征病例。在硬支气管镜活检后，无一例出血引起严重问题。有3例患者的肿瘤据报告为燕麦细胞癌，其中2例是根据纤维支气管镜检查所获材料诊断的。10例行全肺切除术，52例行肺叶切除术，6例行肺段切除术，7例行不切除肺的支气管成形术，2例行肿瘤摘除术，1例行楔形切除术。有1例非典型类癌在手术中发现无法切除。对57例患者进行了5至30年的随访，发现2例在肺切除术后9年和16年出现肿瘤复发。9例采用保留肺组织的保守性支气管切除术治疗的患者未出现复发。经精算评估的生命表分析显示，无复发情况下10年后生存率为94%，15年后为80%，25年后为64%。注意到类癌与燕麦细胞癌的相似性，并分析了其严重的临床意义，特别是鉴于纤维支气管镜检查的使用日益增加。讨论了类癌的恶性潜能及肺切除范围。结论是，肺类癌肿瘤的恶性潜能较小，在合适的病例中可通过支气管切开术或支气管袖状切除术治疗。如果肿瘤远端肺组织发生严重感染性改变或肿瘤已扩展至肺实质（本系列病例中的88%），则有必要行肺切除术。鉴于晚期复发的发生率，随访期应至少为25年。
