表现为慢性咳嗽的青年原发性气管腺样囊性癌误诊分析  

Clinical Misdiagnosis of Primary Adenoid Cystic Carcinoma of the Trachea in Young Patients Presenting with Chronic Cough

作　　者：王辉 王书方 秦芳 白秀云 李小丽 张洁莉 贾卫红 周云芝 WANG Hui;WANG Shufang;QIN Fang;BAI Xiuyun;LI Xiaoli;ZHANG Jieli;JIA Weihong;ZHOU Yunzhi(Department of Respiratory and Critical Care Medicine,Emergency General Hospital,Beijing 100028,China;Department of Respiratory and Critical Care Medicine,Xi'an No.3 Hospital the Affiliated Hospital of Northwest University,Xi'an 710083,China)

机构地区：[1]应急总医院呼吸与危重症医学科,北京100028 [2]西北大学附属医院西安市第三医院呼吸与危重症医学科,西安710083

出　　处：《临床误诊误治》2023年第5期23-26,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的分析表现为慢性咳嗽的青年原发性气管腺样囊性癌误诊原因及防范措施。方法回顾性分析2010年1月—2022年10月以慢性咳嗽为主要表现青年原发性气管腺样囊性癌4例的临床资料。结果本组均因慢性咳嗽就诊,干咳4例,气喘2例,喘憋1例,活动后呼吸困难1例。误诊为慢性支气管炎2例、支气管哮喘2例。误诊时间0.5~2.0年。4例给予抗感染、止咳、平喘等治疗效果不理想,经支气管镜活组织病理检查后确诊为原发性气管腺样囊性癌。确诊后均给予支气管镜介入治疗,未行外科手术治疗。随访时间1~12年,2例病情稳定,另外2例分别在患病第4年、第12年复发,病变范围增大,气道狭窄显著,且伴双肺多发转移灶,目前正在接受支气管镜介入治疗,病情稳定。结论表现为慢性咳嗽的青年原发性气管腺样囊性癌临床及胸部影像学表现不典型,容易误诊。及时行颈段联合胸段CT及支气管镜检查可以早期明确诊断,从而减少误诊及误治。支气管镜下的综合治疗有助于改善患者的临床症状,延长生存时间。Objective To analyze the causes of misdiagnosis and preventive measures of primary adenoid cystic carci⁃noma(ACC)of the trachea in young patients presenting with chronic cough.Methods Clinical data of 4 young patients with primary ACC of the trachea presenting with chronic cough as the main presentation admitted from January 2010 to October 2022 were retrospectively analyzed.Results All patients were treated for chronic cough,including 4 cases of dry cough,2 cases of asthma,1 case of dyspnea and 1 case of dyspnea after exercise.They were misdiagnosed as chronic bronchitis in 2 ca⁃ses and bronchial asthma in 2 cases.The duration of misdiagnosis was 0.5~2.0 years.Four cases were diagnosed as primary ACC of the trachea after bronchoscopy biopsy due to unsatisfactory effects of anti⁃infection and antitussive and antiasthmatic treatment.After diagnosis,all patients received bronchoscopic interventional treatment,and no surgical treatment was per⁃formed.The follow⁃up period was 1⁃12 years.Two patients were stable,and the other 2 patients recurred at the 4th and 12th year respectively,with increased lesions in the airway,significant airway stenosis,and multiple metastases in both lungs.Currently,they were receiving bronchoscopic interventional therapy,with stable condition.Conclusion Young patients with primary ACC of the trachea presenting with chronic cough have atypical clinical and chest imaging findings and are prone to clinical misdiagnosis.Timely cervical CT combined with chest CT and bronchoscopy can clearly diagnose the disease at an early stage,thus reducing the misdiagnosis and mistreatment of the disease.Combined bronchoscopic treatment can improve the clinical symptoms and prolong the survival of patients.

关 键 词：慢性咳嗽 气管腺样囊性癌 青年人 误诊 支气管哮喘 支气管炎 慢性 支气管镜检查 气道阻塞 

分 类 号：R734.2[医药卫生—肿瘤]