【摘要】 目的 介绍河北医科大学第二医院收治的1例气管腺样囊性癌患者，经可弯曲支气管镜介入治疗联合放化疗取得良好效果，旨在增加对气管腺样囊性癌患者的支气管镜介入治疗以及化疗效果的认识。方法 CT及支气管镜明确气管右侧壁占位，后于全麻下通过硬质气管镜联合可弯曲支气管镜诊治，内镜所见：气管下段右侧壁菜花样新生物生长，阻塞管腔约50%,新生物长约2 cm,下端距隆突约1 cm,予以电圈套切除新生物，残端部分予以二氧化碳冷冻处理。术后至当地医院行放疗。患者4年半后，气道肿物复发，CT提示：主支气管内可见软组肿块；两肺上叶及左肺下叶可见多发斑片状及结节状高密度及磨玻璃密度影，边界不清，周围可见毛刺，不除外肿瘤性病变；纵膈多发淋巴结，部分稍大。支气管镜下可见气管中下段可见球形肿物阻塞管腔75%,基底于膜部增宽，肿物上缘距声门6 cm。后经喉罩置入可弯曲支气管镜，圈套套取肿物，残留部分经冷冻冻取，并给予APC电凝止血治疗。术后给予白蛋白紫杉醇200 mg d1、d8+顺铂60 mg d1～2方案化疗。结果 患者经第一次气管镜下电圈套切除、冷冻及放疗后，获得了较长时间的无复发生存。4年半后肿瘤复发，第二次经喉罩置入可弯曲支气管镜圈套切除肿瘤，并给予两周期化疗后，患者病灶明显缩小，目前一般情况良好。结论 经可弯曲支气管镜介入治疗气管腺样囊性癌并联合放化疗，可使患者获得较好的治疗效果，并且，操作相对简单，损伤明显减少，便于重复治疗，改善了患者的生存质量，在不能选择手术的患者中值得进一步推广。更多还原

【Abstract】 Objective To report a case of adenoid cystic carcinoma of the trachea admitted to the Second Hospital of Hebei Medical University who has achieved good outcomes after interventional flexible bronchoscopy combined with radiotherapy and chemotherapy. This study aims to increase the understanding of the adenoid cystic carcinomas of the trachea managed by interventional flexible bronchoscopy and chemotherapy outcomes.Methods CT and bronchoscopy confirmed an occupying lesion on the right-sided wall of the trachea. An adenoid cystic carcinoma of the trachea was finally diagnosed by interventional rigid and flexible bronchoscopy under general anesthesia. Endoscopic findings revealed a cauliflower-like neoplasm(2cm in length) on the wall of the lower trachea on the right side, the distal end of which was 1cm away from the carina. The neoplasm resulted in a 50% lumen blockage. It was resected using an electric snare, and the stump was frozen with carbon dioxide. Postoperative chemotherapy was performed in the local hospital. After four and a half years of surgery, the patient developed recurrence of airway neoplasms. CT scans suggested:(1) a soft mass in the main bronchus;(2) multiple patchy and nodular high-density and ground-glass shadows in the upper lobes of both lungs and the lower lobe of the left lung, with unclear borders and surrounding burrs, suggesting the possibility of tumor lesions;(3) multiple lymph nodes in the mediastinum, some of which were slightly enlarged. Bronchoscopy showed a spherical mass in the middle and lower segment of the trachea blocking 75% of the lumen. The base of the mass was widened at the membranous part, and the upper edge of the mass was 6cm away from the glottis. A flexible bronchoscope was inserted through the laryngeal mask, and the tumor was resected with a snare. The remaining tumor lesions were frozen. Argon plasma coagulation(APC) was performed for hemostasis. Postoperative chemotherapy regimen of albumin paclitaxel 200mg on day 1 and day 8 plus cisplatin 60mg on day 1-2 was applied.Results A longer recurrence-free survival was yielded after the initial cold snare resection, cryotherapy and radiotherapy. Tumor recurrence occurred four and a half years later. The recurrent tumor was significantly shrunk after tumor resection using the flexible bronchoscopy and two cycles of chemotherapy. The patient was in a good condition at present.Conclusion Interventional flexible bronchoscopy combined with radiotherapy and chemotherapy is featured by simple procedures, less damages and convivence for repeated treatment for patients with adenoid cystic carcinomas of the trachea. It yields acceptable outcomes and improves the survival, deserving a further promotion to patients who are contraindicative to surgeries.更多还原