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頁籤選單縮合
題名 | Descriptive Study of Prognostic Factors Influencing Survival of Patients with Primary Tracheal Tumors=原發性氣管腫瘤之預後因子的探討 |
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作者姓名(中文) | 李政輝; 林鴻銓; | 書刊名 | 長庚醫學 |
卷期 | 18:3 1995.09[民84.09] |
頁次 | 頁224-230 |
分類號 | 415.426 |
關鍵詞 | 原發性氣管腫瘤; 預後因素; 存活; Primary tracheal tumor; Prognostic factors; Survival; |
語文 | 英文(English) |
中文摘要 | 原發性氣管腫是一種罕見的疾病,至今全世異之報告供不超過1200例。雖然隨著診斷及治療方法的進步,其存活率仍不甚理想;因此,對於影響預後之原因,有必要加以進一步探討。 長庚醫院臺北院區在民國66年到民國81年之間,共有23側原發性氣管腫瘤的病例,其中18例是鱗狀細胞癌(squamous cell carcinoma),2例是線樣囊癌(adenold cystic carcinoma),1例是小細胞癌(small cell carcinoma),1例是未分化細胞癌(poorly differential carcinoma),另外1例是多形性腺腫。鱗狀細胞癌、小細胞癌及未分化細胞癌的病例中,特別是伴有聲帶麻痺者(26%),其預後較差。有9例腫瘤的位置在氣管的上2/3,其中7例存活率小於1年,4例有急性呼吸窘迫的現象。臨床上,咳嗽(65.2%)、呼吸困難(91.3%)及咳血(47.8%)是最常見的症狀;不過統計上,有聲音嘶啞、吞咽困難或頸部淋巴結腫大的病例,其預後較差(p<0.001)。2例(8.7%)伴有多發惡性腫瘤患者,都在一年內死內。抽煙在以前的報告中,原本認為是一個原發性氣管腫的誘發因子,但我們發現跟預後也有相關聯。在治療方法上,緊急放射線治療只有助於急性呼吸窘迫的緩解;若是要獲致較佳的預後,必須要合併使用放射線治療及外科手術治療(p=0.02)。 總而言之,原發性氣管腫瘤的預後,取決於腫瘤的組織型態、所在的血置、病人的臨床表徵、抽煙史以及治的積極與否,而與腫瘤的X-光表現及腫瘤的大小無關;而這些因子,有助於臨床上評估病人的存活率。 |
英文摘要 | From 1977 to 1992, 23 patients with primary tumors of the trachea were reviewed. Nineteen of these patiens had squamous cell carcinomas, 2 had adenoid cystic carcinomas, 1 had a small cell carcinoma, 1 had a poorly differentiated carcinoma, and 1 had a pleomorphic adenoma. The prognosis of squamous cell, small cell and poorly differentiated carcinomas appeared to be grave, especially in association with vocal cord palsy (26%). Short-term survival occurred in 7 of 9 patients with tumors in the upper-middle third of trachea and 4 of them had concurrent acute respiratory distress. Cough (65.2%), dyspnea (91.3%), and hemoptysis (47.8%) were the most common symptoms. For patients with hoarseness, dysphagia, and cervical lymphadenopathy, the prognosis was poor (p<0.0010). Two patients(8.7%) had multiple malignancies and all died within 1 years. Smoking was not only a risk factor as reported in previous studies, but also a significant prognostic factor (p=0.0020) in our series. Emergent irradiation (<40 Gy in our cases) was useful in alleviating acute respiratory distress, but worthwhile survival was only obtained by the combination of surgery and radiation therapy (p=0.0200, compared with surgery or irradiation, respectively). There was a significant correlation between prognosis and histologic type, tumor location, clinical presentation, smoking history and management, but not roentography or tumor size. These factors can be used to assess the survival of patients with primary tracheal tumors. |
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