Refaely Y, Weissberg D
Department of Thoracic Surgery, Tel Aviv University Sackler School of Medicine, Israel.
Ann Thorac Surg. 1997 Nov;64(5):1429-32; discussion 1432-3. doi: 10.1016/S0003-4975(97)00818-7.
Resection of tracheal tumors is particularly challenging when the neoplasm involves the carina or is located in close proximity. We reviewed our experience with 22 tracheal resections for tumor.
In this retrospective review, adenoid cystic carcinoma was diagnosed in 13 patients, squamous cell carcinoma in 5, typical carcinoid in 2, and leiomyoma and benign fibrous histiocytoma, in 1 each. There were 19 segmental resections with direct anastomosis, and 3 complex resections in which the carina was involved.
One patient with tumor in the trachea and left main bronchus underwent resection through simultaneous bilateral thoracotomy and died. During 2 to 17 years of follow-up, 2 patients died of unrelated disease, 2 died of metastases, and 1 is receiving radiotherapy for recurrence. Sixteen patients are well and free of tumor.
Complete resection of all neoplastic tissue is mandatory, but benign and low-grade malignant tumors should be resected conservatively with preservation of lung parenchyma. Options for treatment of neoplasms involving trachea and left bronchus should include resection of the neoplasm in two stages, thus minimizing trauma of each operation.
当气管肿瘤累及隆突或位于其附近时，气管肿瘤切除术极具挑战性。我们回顾了22例气管肿瘤切除术的经验。
在这项回顾性研究中，13例患者诊断为腺样囊性癌，5例为鳞状细胞癌，2例为典型类癌，1例为平滑肌瘤，1例为良性纤维组织细胞瘤。19例为直接吻合的节段性切除术，3例为累及隆突的复杂切除术。
1例气管及左主支气管肿瘤患者经双侧开胸同时手术切除后死亡。在2至17年的随访中，2例患者死于无关疾病，2例死于转移，1例因复发接受放疗。16例患者情况良好，无肿瘤。
必须完整切除所有肿瘤组织，但对于良性和低级别恶性肿瘤，应在保留肺实质的情况下进行保守切除。对于累及气管和左支气管的肿瘤，治疗方案应包括分两期切除肿瘤，从而将每次手术的创伤降至最低。
