原发性气管腺样囊性癌误诊为支气管哮喘  

Primary Adenoid Cystic Carcinoma of Trachea Misdiagnosed as Bronchial Asthma

作　　者：李朝霞[1] 赵伟[1] 王英[1] 宋云熙[1] 

机构地区：[1]第二炮兵总医院呼吸内科,北京100088

出　　处：《临床误诊误治》2012年第5期23-24,共2页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨气管腺样囊性癌(adenoid cystic carcinoma,ACC)的误诊原因,以减少误诊误治。方法回顾性分析1例原发性气管ACC误诊为支气管哮喘的临床资料,并复习相关文献。结果患者表现为发作性咳嗽、咳痰伴气喘,在当地医院多次就诊,误诊为支气管炎、支气管哮喘,后渐出现痰中带血、呼吸困难、持续喘憋、发绀,以哮喘持续状态转入我院。无创呼吸机辅助通气等治疗无效,纤维支气管镜引导下经鼻气管插管时发现距隆突约5 cm处一肿物堵塞主气管约4/5,取材病理检查诊断为气管ACC,先后2次于全麻下经气管镜行高频电圈圈套联合冷冻刀、氩气刀切除全部肿瘤。术后症状基本缓解。结论气管ACC临床症状不典型,易误诊为支气管哮喘,诊断方法首选胸部CT及纤维支气管镜检查,手术切除结合术后放疗是最佳治疗方法,纤维支气管镜下介入治疗是较好的姑息治疗手段。Objective To explore the cause of misdiagnosis of adenoid cystic carcinoma （ACC） of trachea and to re- duce its misdiagnosis and mistreatment rates. Methods Clinical data of primary ACC of trachea misdiagnosed as bronchial asthma was retrospectively analyzed and pertinent literature was reviewed. Results The patient had a sudden onset of cough and expectoration with asthma, and was misdiagnosed as having bronchitis or bronchial asthma in a local hospital, later in the course of the disease, the patient had blood-streaked sputum, and suffered from dyspnea, persistent asthma and cyanosis. The patient was admitted for continuous asthma. Assisted ventilation with breathing apparatus was invalid. Nasotraeheal intubation guided by fiberoptic bronchoscope illustrated a solid mass originating from the main trachea at 5 cm proximal of the carina. The lesion was occupying approximately 4/5 of the main trachea. Histopathological diagnosis was ACC of the trachea. The whole tumor was re- moved after two operations of high-frequency electrocautery facilitated with frozen knife and argon plasma coagulation via hron- choscopy under general anesthesia. The clinical symptoms were remarkably relieved postoperative. Conclusion The clinical symptoms of primary trachea ACC is not typical, and may be misdiagnosed as bronchial asthma. Chest CT and fiheroptie hron- choscope are preferred as the first option in examination, and excision followed by radiotherapy is the best treatment approach and interventional therapy under fibro brobronchoscopy is also recornmended as a way of palliative treatment.

关 键 词：气管肿瘤 误诊 哮喘 

分 类 号：R734.1[医药卫生—肿瘤]