ﺗﻮﻣﻮرﻫﺎي ﻛﺎرﺳﻴﻨﻮﺋﻴﺪ ﺑﺮوﻧﺶ ـ ﺑﺮرﺳﻲ اﻗﺪاﻣﺎت ﺗﺸﺨﻴﺼﻲ، درﻣﺎﻧﻲ و ﻧﺘﺎﻳﺞ در ﺑﻴﻤﺎران ﺑﻴﻤﺎرﺳﺘﺎن دﻛﺘﺮ ﻣﺴﻴﺢ داﻧﺸﻮري در ﻃﻲ ﺳﺎل ﻫﺎي 1376 ﻟﻐﺎﻳﺖ 1386

Bronchial Carcinoid Tumors - Evaluation of our Experience in Diagnosis, Treatment and Results in the Patients of Massih Daneshvari Hospital between 1996-2007

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺗﻮﻣـﻮﺭﻫﺎﻱ ﻛﺎﺭﺳﻴﻨﻮﺋﻴﺪ ﺑﺮﻭﻧﺶ ﺟﺰﺀ ﺗـﻮﻣﻮﺭﻫﺎﻱ ﻧﺴﺒﺘﺎﹰ ﻧﺎﺩﺭ، ﺑﺎ ﺭﺷﺪ ﺑﻄﺌﻲ ﻭ ﻋﻼﺋﻢ ﺑﺎﻟﻴﻨﻲ ﻣﺒﻬﻢ ﻣﻲ ﺑﺎﺷﻨﺪ ﻛﻪ ﻣﻲ ﺗﻮﺍﻧﻨﺪ ﺑﺴﻴﺎﺭﻱ ﺍﺯ ﺳﻨـﺪﺭﻡ ﻫﺎﻱ ﺗﻨﻔﺴﻲ ﺭﺍ ﺗﻘﻠﻴﺪ ﻧﻤﺎﻳﻨﺪ. ﻣﻄﺎﻟﻌﻪ ﺍﻱ ﺩﺭ ﻣـﺮﻛﺰ ﻣﺎ ﺩﺭ ﻣﺪﺕ 11 ﺳﺎﻝ( ﺟﻬﺖ ﺑﺮﺭﺳﻲ ﻣﺸﺨﺼﺎﺕ ﺑﺎﻟﻴﻨﻲ، ﺍﻗﺪﺍﻣﺎﺕ ﺗﺸﺨﻴﺼﻲ ﻭ ﺩﺭﻣﺎﻧﻲ ﺍﻧﺠﺎﻡ ﺷﺪﻩ ﻭ ﻧﺘﺎﻳﺞ ﺣﺎﺻﻠﻪ ﺩﺭ ﻃﻮﻝ ﺯﻣﺎﻥ، ﺻﻮﺭﺕ ﮔﺮﻓﺖ. ﻫﺪﻑ، ﮔﺰﺍﺭﺵ ﺗﺠﺮﺑﻪ ﻣﺎ ﺩﺭ ﺩﺭﻣﺎﻥ ﺍﻳﻦ ﺑﻴﻤﺎﺭﺍﻥ ﻣﻲ ﺑﺎﺷﺪ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺑﺎ ﺗﻬﻴﻪ ﻭ ﺗﻜﻤﻴﻞ ﻓﺮﻡ ﻫﺎﻱ ﻛﺎﻣﭙﻴﻮﺗﺮﻱ ﺑﺮﺍﻱ ﺍﻳﻦ ﺑﻴﻤـﺎﺭﺍﻥ ﻭ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﻧﺮﻡ ﺍﻓـﺰﺍﺭﻫﺎﻱ Access, SPSS ﻭ ﺁﺯﻣـﻮﻥ ﻫﺎﻱ Fisher Exact ﻭ Mc Nemar ﺍﻃﻼﻋﺎﺕ ﻣﺮﺑﻮﻁ ﺑﻪ ﺳﻦ، ﺟﻨﺲ، ﻋﻼﺋﻢ ﺑﺎﻟﻴﻨﻲ، ﺳﺎﺑﻘﺔ ﻣﺼـﺮﻑ ﺩﺧـﺎﻧﻴﺎﺕ ﻭ ﺍﻗـﺪﺍﻣﺎﺕ ﺗﺸﺨﻴﺼﻲ ﺩﺭﻣﺎﻧﻲ ﻭ ﻧﺘﺎﻳﺞ ﺣﺎﺻﻞ ﺍﺯ ﭘﻴﮕﻴﺮﻱ ﺍﻳﻦ ﺑﻴﻤﺎﺭﺍﻥ ﻣﻮﺭﺩ ﺗﺠﺰﻳﻪ ﻭ ﺗﺤﻠﻴﻞ ﺁﻣﺎﺭﻱ ﻗﺮﺍﺭ ﮔﺮﻓﺖ. ﺍﻳﻦ ﺑﺮﺭﺳﻲ ﻇﺮﻑ 11 ﺳﺎﻝ )1376-1386 ﻭ ﺑﺎ ﭘﻴﮕﻴﺮﻱ ﻛﺎﻣﻞ ﺩﺭ 86/4 ﻣﻮﺍﺭﺩ ﺻﻮﺭﺕ ﮔﺮﻓﺖ. ﻳﺎﻓﺘﻪ ﻫﺎ: 73 ﺑﻴﻤـﺎﺭ38 ﺯﻥ، 35 ﻣﺮﺩ( ﺑﺎ ﻣﻴﺎﻧﮕﻴﻦ ﺳﻨﻲ 41/4 ﺳﺎﻝ )11 ﺗﺎ 70 ﺳﺎﻝ( ﺑﺎ ﺗﺸﺨﻴﺺ ﺗﻮﻣﻮﺭ ﻛﺎﺭﺳﻴﻨﻮﺋﻴﺪ ﺗﺤﺖ ﺩﺭﻣﺎﻥ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻨﺪ. ﺍﻋﻤـﺎﻝ ﺟﺮﺍﺣـﻲ ﺻـﻮﺭﺕ ﮔﺮﻓﺘﻪ ﺍﺯ ﺭﺯﻛﺴﻴـﻮﻥ ﮔـﻮﻩ ﺍﻱ ﺗﺎ ﭘﻨﻮﻣﻮﻧﻜﺘﻮﻣﻲ ﺑﺎ ﻳﺎ ﺑﺪﻭﻥ ﺩﻳﺴﻜﺴﻴـﻮﻥ ﻏﺪﺩ ﻟﻨﻔﺎﻭﻱ ﻣﺪﻳﺎﺳﺘﻦ ﺑﻮﺩ. ﺩﺭ ﺑﻌﻀﻲ ﻣـﻮﺍﺭﺩ ﻗﺒﻞ ﺍﺯ ﺍﻗــﺪﺍﻡ ﺟــﺮﺍﺣﻲ ﺳـﺎﻳﺮ ﺭﻭﺵ ﻫـﺎﻱ ﺩﺭﻣـﺎﻧﻲ ﭼـﻮﻥ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﻟﻴﺰﺭ (ND-YAG) ﻭ ﻳﺎ ﺭﺯﻛﺴﻴﻮﻥ ﺑﺮﻭﻧﻜـﻮﺳﻜﻮﭘﻴﻚ ﺻﻮﺭﺕ ﮔﺮﻓﺘﻪ ﺑﻮﺩ. 2 ﻣﻮﺭﺩ ﻋـﻮﺩ ﺗﻮﻣـﻮﺭ ﺩﺭ ﻟﻨﻔﺎﺗﻴﻚ ﻫﺎ ﻭﺟﻮﺩ ﺩﺍﺷﺖ. ﺩﺭ ﻇﺮﻑ ﺍﻳﻦ ﻣﺪﺕ، 6 ﺑﻴﻤﺎﺭ )8/2 ﻓﻮﺕ ﻧﻤﻮﺩﻧﺪ ﻛﻪ 4 ﺑﻴﻤﺎﺭ ﺟﺰﺀ ﺑﻴﻤﺎﺭﺍﻥ ﺟﺮﺍﺣﻲ ﺷﺪﻩ ﺍﺯ ﻛﻞ ﺑﻴﻤﺎﺭﺍﻥ ﺟﺮﺍﺣﻲ ﺷﺪﻩ( ﻭ ﺗﻨﻬﺎ ﻳﻚ ﻣﻮﺭﺩ ﻧﺎﺷﻲ ﺍﺯ ﻋﻮﺍﺭﺽ ﻣﺴﺘﻘﻴﻢ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﺑﻮﺩ. 2 ﻣﻮﺭﺩ ﺩﻳﮕﺮ ﺍﺯ ﺑﻴﻤﺎﺭﺍﻥ ﺟﺮﺍﺣﻲ ﻧﺸﺪﻩ ﺑﻮﺩﻧﺪ )28/6 ﺍﺯ ﻛﻞ ﺑﻴﻤـﺎﺭﺍﻥ ﺟﺮﺍﺣﻲ ﻧﺸﺪﻩ(. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺗﻮﻣـﻮﺭﻫﺎﻱ ﻛﺎﺭﺳﻴﻨﻮﺋﻴﺪ ﺑﺮﻭﻧﺶ ﺑﺎ ﺭﺷﺪ ﺑﻄﺌﻲ ﺍﻏﻠﺐ ﺗﺎ ﺗﺸﺨﻴـﺺ ﻗﻄﻌﻲ ﺑﻪ ﻋﻨﺎﻭﻳﻦ ﺩﻳﮕﺮ ﺩﺭﻣﺎﻥ ﻣﻲ ﮔﺮﺩﻧﺪ. ﺗﻮﺍﻧﺎﻳﻲ ﺑﺮﻭﻧﻜﻮﺳﻜﻮﭘﻲ ﻓﻴﺒﺮﻭﭘﺘﻴﻚ ﺩﺭ ﻳﺎﻓﺘﻦ ﺍﻳﻦ ﺗﻮﻣﻮﺭﻫﺎ ﺑﻴﺸﺘﺮ ﺍﺯ ﺑﺮﻭﻧﻜﻮﺳﻜﻮﭘﻲ ﺭﻳﮋﻳﺪ ﺍﺳﺖ P-value=0.04( ﺩﺭ ﺣﺎﻟﻴﻜﻪ ﺩﺭ ﻫﻨﮕﺎﻡ ﻧﻤﻮﻧﻪ ﺑﺮﺩﺍﺭﻱ، ﺑﻪ ﻋﻠﺖ ﺭﻳﺴﻚ ﺧﻮﻧﺮﻳﺰﻱ ﻫﻤﻮﺍﺭﻩ ﺑﺎﻳﺪ ﺑﺮﻭﻧﻜﻮﺳﻜﻮﭘﻲ ﺭﻱ ﮊﻳﺪ ﺩﺭ ﺩﺳﺘـﺮﺱ ﺑﺎﺷﺪ. ﺩﺭﻣﺎﻥ ﺍﻳﻦ ﺗﻮﻣﻮﺭﻫﺎ ﺟﺮﺍﺣﻲ ﺑﺎ ﺣﻔﻆ ﺣﺪﺍﻛﺜﺮ ﭘﺎﺭﺍﻧﺸﻴﻢ ﻣﻤﻜﻦ ﺑﻪ ﻫﻤـﺮﺍﻩ ﺩﻳﺴﻜﺴﻴﻮﻥ ﻟﻨﻔﺎﻭﻱ ﻣﺪﻳﺎﺳﺘﻦ ﺧﺼﻮﺻﺎﹰ ﺩﺭ ﻧﻮﻉ ﺁﺗﻴﭙﻴﻚ ﺍﺳـﺖ ﻋـﻮﺩ ﻣﻮﺿـﻌﻲ ﺩﺭ ﺑﻴﻤـ ﺎﺭﺍﻥ ﻣـﺎ ﻫﻤﻮﺍﺭﻩ ﺩﺭ ﻏـﺪﺩ ﻟﻨﻔﺎﻭﻱ ﺑﻮﺩﻩ ﺍﺳﺖ. ﺩﺭﻣﺎﻥ ﻋـﻮﺩ، ﺩﺭ ﺻﻮﺭﺕ ﺍﻣﻜﺎﻥ ﺟﺮﺍﺣﻲ ﻣﺠـﺪﺩ ﺍﺳﺖ. ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺭﻭﺵ ﻫﺎﻳﻲ ﭼﻮﻥ ﺭﺯﻛﺴﻴﻮﻥ ﺁﻧﺪﻭﺳﻜﻮﭘﻴﻚ ﻭ ﻳﺎ ﻟﻴﺰﺭ ﺑﻪ ﻣﻨﻈﻮﺭ ﻛﻤﻚ ﺩﺭ ﺗﻌﻴﻴﻦ ﻣﻨﺸﺎﺀ ﺗﻮﻣﻮﺭ، ﺑﺮﻃﺮﻑ ﻛﺮﺩﻥ ﺍﻧﺴﺪﺍﺩ ﻭ ﻋﻔﻮﻧﺖ ﺩﻳﺴﺘﺎﻝ ﺑﻪ ﺁﻥ ﻛﻤﻚ ﻛﻨﻨﺪﻩ ﺍﺳﺖ. ﻧﻘﺶ ﻛﻤﻮﺗﺮﺍﭘﻲ ﻭ ﺭﺍﺩﻳﻮﺗﺮﺍﭘﻲ ﺩﺭ ﺣﺎﻝ ﺣﺎﺿﺮ ﻧﺎﻣﺸﺨﺺ ﻭ ﻣﺒﻬﻢ ﺍﺳﺖ.

Introduction & Objective: Bronchial carcinoids are rare, slow growing neoplasms with nonspecific clinical signs which can mimic many respiratory syndromes. To evaluate clinical presentations, diagnosis and modes of treatment of these tumors in long term, a clinical research was performed in our center. The aim of this presentation is to report our experience. Materials & Methods: By completing the prepared computerized data sheets for these patients and use of SPSS and Access softwares and Fisher exact and Mc Nemar tests, informations about age, sex, clinical signs, Hx of smoking, diagnosis and the results were evaluated. The evaluation took eleven years (1996-2007) therapies, with a complete follow up in 86.4% of the patients. Results: 73 patients (38 women, 35 men) with mean age 41.4 years-old (range 11-70) were treated, with diagnosis of bronchial carcinoids. Surgical resections (from wedge resection to pneumonectomy) with or without mediastinal lymph node dissection (MLND) were performed. Other therapies such as bronchoscopic resections or ND YAG laser ablation were done before surgery in some patients. There were two recurrences both in lymphatics (2.7%). During this period 6 patient's (8.2%) have been died, 4 from operated patients (%6 of total operated ones) and one due to surgical complication and 2 were among non-operated ones (28.6% of non-operated cases). Conclusions: Bronchial carcinoids with slow progression are often treated as other diagnoses before definite diagnosis. Fiberoptic bronchoscopy is more accurate in their findings than rigid broncoscopy (P= 0.04), were as considering that rigid bronchoscope should be available during biopsy time due to the high risk of hemorrhage. Their treatment is surgical resection (maintaining as much paranchyma as possible) with mediastinal lymph node dissection especially in atypical ones. Local recurrence was in lymphatics in our patients. When possible, re-resection is the treatment of choice for recurrences. The use of endoscopic resection or laser ablation in finding tumoral origin or in treating obstruction and infection distal to it might be helpful. Role of chemotherapy and radiation aren't clearly obvious.