• 中國醫(yī)學(xué)科學(xué)院 中國協(xié)和醫(yī)科大學(xué) 北京協(xié)和醫(yī)院 胸外科， 北京 100730;

目的 探討胸腺類癌的臨床表現(xiàn)，分類與預(yù)后的關(guān)系，以及手術(shù)方式及術(shù)后輔助治療特點(diǎn)，以提高對(duì)該病的認(rèn)識(shí)。 方法 回顧性分析北京協(xié)和醫(yī)院1980年1月至2006年1月18例胸腺類癌的外科治療和隨診結(jié)果。開胸探查活檢2例，姑息性切除2例，完整切除14例，包括2例上腔靜脈系統(tǒng)切除移植人工血管。采用壽命表法計(jì)算生存率，用Cox單因素回歸模型分析胸腺類癌預(yù)后的影響因素。 結(jié)果 2例行開胸探查患者分別于術(shù)后1年和2年死亡；2例姑息性切除術(shù)后患者癥狀暫時(shí)緩解；完整切除患者除1例合并柯興綜合征術(shù)后2周死于敗血癥，其余13例術(shù)后完全恢復(fù)，隨診5個(gè)月至15年良好。全組3年、5年、10年生存率分別為72.6%、60.5%和40.3%。經(jīng)Cox單因素分析結(jié)果：縱隔淋巴結(jié)轉(zhuǎn)移(P=0047)、病理類型(P=0000)、手術(shù)方式(P=0000)和術(shù)后綜合治療(P=0018)是影響預(yù)后的因素。 結(jié)論 胸腺類癌不同于胸腺瘤、胸腺癌，臨床診斷困難；病理學(xué)分典型和不典型胸腺類癌，兩者臨床表現(xiàn)和預(yù)后明顯不同。不典型類癌惡性程度高，切除后容易復(fù)發(fā)和轉(zhuǎn)移，預(yù)后較差。徹底切除腫瘤以及受侵的組織和器官，可以明顯提高長期生存率。術(shù)后放療、化療有一定輔助作用。

引用本文： 郭峰,張志庸,崔玉尚等. 胸腺類癌外科治療的長期結(jié)果. 中國胸心血管外科臨床雜志, 2007, 14(6): 422-. doi: 復(fù)制

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2. 　Detterbeck FC, Parsons AM. Thymic? tumors. Ann Thorac Surg, 2004, 77(5): 1860-1869.
3. 　張志庸,郝武森,任華,等. 胸腺類癌(附7例報(bào)告). 中華腫瘤雜志, 1992, 14(5): 382-384.
4. 　黃進(jìn)豐,汪良駿,李鑒,等.胸腺類癌4例. 中華胸心血管外科雜志, 1999, 15(6): 363.
5. 　朱全,陳廣明,朱寧. 胸腺類癌的外科治療. 中國腫瘤臨床與康復(fù), 2001, 8(3): 85-86.
6. 　鐘華,陳崗,韓寶惠.8例胸腺類癌的臨床分析. 腫瘤學(xué)雜志, 2002, 8(4): 236-237.
7. 　de Perrot M, Spiliopoulos A, Fischer S, et al. Neuroendocrine carcinoma (carcinoid) of the thymus associated with Cushing’s syndrome. Ann Thorac Surg, 2002, 73(2):675-681.
8. 　Filosso PL, Actis Dato GM, Ruffini E, et al. Multidisciplinary treatment of advanced thymic neuroendocrine carcinoma (carcinoid): Report of a successful case and review of the literature. J Thorac Cardiovasc Surg, 2004,127(4): 1215-1219.
9. 　Liu HC, Hsu WH, Chen YJ, et al. Primary thymic carcinoma. Ann Thorac Surg,2002,73(4): 1076-1081.??.
10. 　Markou A, Manning P, Kaya B, et al. [18F]fluoro-2-deoxy-D-glucose ([18F]FDG) positron emission tomography imaging of thymic carcinoid tumor presenting with recurrent Cushing’s syndrome. Eur J Endocrinol, 2005,152(4): 521-525.
11. 　Arrigoni MG, Woolner LB, Bernatz PE. Atypical carcinoid tumors of the lung. J Thorac Cardiovasc Surg,1972,64(3): 413-421.
12. 　Travis WD, Rush W, Flieder DB, et al. Survival analysis of 200 pulmonary neuroendocrine tumors with clarification of criteria for atypical carcinoid and its separation from typical carcinoid. Am J Surg Pathol, 1998, 22(8): 934-944.
13. 　Rosai J, Sobin LH. World Health Organization International Histological Classification of Tumors: Histological Typing of Tumors of the Thymus, 2nd ed. Berlin: Springer Verlag, 1999. 15-18.
14. 　Gal AA, Kornstein MJ, Cohen C, et al. Neuroendocrine tumors of the thymus: a clinicopathological and prognostic study. Ann Thorac Surg, 2001, 72(4):1179-1182.
15. 　Sakuragi T, Rikitake K, Nastuaki M, et al.Complete resection of recurrent thymic carcinoid using cardiopulmonary bypass. Eur J Cardiothorac Surg, 2002, 21(1):152-154.
16. 　Chaer R, Massad MG, Evans A, et al. Primary neuroendocrine tumors of the thymus. Ann Thorac Surg, 2002, 74(5):1733-1740.
17. 　Tiffet O, Nicholson AG, Ladas G, et al. A clinicopathologic study of 12 neuroendocrine tumors arising in the thymus. Chest, 2003,124(1):141-146.
  1. 1. 　Rosai J, Higa E. Mediastinal endocrine neoplasm of probable thymic origin, related to carcinoid tumor. Clinicopathologic study of 8 cases. Cancer, 1972, 29(4):1061-1074.
  2. 2. 　Detterbeck FC, Parsons AM. Thymic? tumors. Ann Thorac Surg, 2004, 77(5): 1860-1869.
  3. 3. 　張志庸,郝武森,任華,等. 胸腺類癌(附7例報(bào)告). 中華腫瘤雜志, 1992, 14(5): 382-384.
  4. 4. 　黃進(jìn)豐,汪良駿,李鑒,等.胸腺類癌4例. 中華胸心血管外科雜志, 1999, 15(6): 363.
  5. 5. 　朱全,陳廣明,朱寧. 胸腺類癌的外科治療. 中國腫瘤臨床與康復(fù), 2001, 8(3): 85-86.
  6. 6. 　鐘華,陳崗,韓寶惠.8例胸腺類癌的臨床分析. 腫瘤學(xué)雜志, 2002, 8(4): 236-237.
  7. 7. 　de Perrot M, Spiliopoulos A, Fischer S, et al. Neuroendocrine carcinoma (carcinoid) of the thymus associated with Cushing’s syndrome. Ann Thorac Surg, 2002, 73(2):675-681.
  8. 8. 　Filosso PL, Actis Dato GM, Ruffini E, et al. Multidisciplinary treatment of advanced thymic neuroendocrine carcinoma (carcinoid): Report of a successful case and review of the literature. J Thorac Cardiovasc Surg, 2004,127(4): 1215-1219.
  9. 9. 　Liu HC, Hsu WH, Chen YJ, et al. Primary thymic carcinoma. Ann Thorac Surg,2002,73(4): 1076-1081.??.
  10. 10. 　Markou A, Manning P, Kaya B, et al. [18F]fluoro-2-deoxy-D-glucose ([18F]FDG) positron emission tomography imaging of thymic carcinoid tumor presenting with recurrent Cushing’s syndrome. Eur J Endocrinol, 2005,152(4): 521-525.
  11. 11. 　Arrigoni MG, Woolner LB, Bernatz PE. Atypical carcinoid tumors of the lung. J Thorac Cardiovasc Surg,1972,64(3): 413-421.
  12. 12. 　Travis WD, Rush W, Flieder DB, et al. Survival analysis of 200 pulmonary neuroendocrine tumors with clarification of criteria for atypical carcinoid and its separation from typical carcinoid. Am J Surg Pathol, 1998, 22(8): 934-944.
  13. 13. 　Rosai J, Sobin LH. World Health Organization International Histological Classification of Tumors: Histological Typing of Tumors of the Thymus, 2nd ed. Berlin: Springer Verlag, 1999. 15-18.
  14. 14. 　Gal AA, Kornstein MJ, Cohen C, et al. Neuroendocrine tumors of the thymus: a clinicopathological and prognostic study. Ann Thorac Surg, 2001, 72(4):1179-1182.
  15. 15. 　Sakuragi T, Rikitake K, Nastuaki M, et al.Complete resection of recurrent thymic carcinoid using cardiopulmonary bypass. Eur J Cardiothorac Surg, 2002, 21(1):152-154.
  16. 16. 　Chaer R, Massad MG, Evans A, et al. Primary neuroendocrine tumors of the thymus. Ann Thorac Surg, 2002, 74(5):1733-1740.
  17. 17. 　Tiffet O, Nicholson AG, Ladas G, et al. A clinicopathologic study of 12 neuroendocrine tumors arising in the thymus. Chest, 2003,124(1):141-146.