原发性中叶肺癌的特征及外科治疗

Analysis of the clinical characteristics and surgical treatment of primary lung cancer in middle lobe

目的 回顾分析原发性中叶肺癌的临床特征及外科治疗结果。方法 从 1976年至 1998年 ,治疗原发性中叶肺癌 12 3例 ,均采取手术治疗。结果 手术方式 :单纯中叶切除 32例 ,中叶袖状切除 5例 ,中上叶切除或中下叶切除术 86例。结论 中叶原发性肺癌发病率低 (10 4 % ) ,多见于女性。病变常累及上叶或下叶 ,中叶支气管旁淋巴结转移常见。单纯中叶切除难度大 ,常需行中上叶或中下叶切除 ,中叶袖状切除由于并发症多宜慎用。以中上叶或中下叶切除为宜 ,有报道说明扩大的肺切除术后生存比肺叶切除要好[5] 。由于中叶支气管管径小 ,中叶体积小 ,中叶肺癌常常累及至支气管口 ,此时宜行中叶袖状切除术 ,本组 5例中叶袖切术后效果良好。中叶袖状切除时 ,中叶支气管口与下叶背段的位置紧密 ,因此应注意勿损伤下叶背段 ,否则易发生术后下叶背段肺不张。但是 ,是否袖状切除或全肺切除以及考虑到肺癌的分期等综合因素时目前的观点还不统一[6,7] 。

Objective To analyse the clinical characteristics and surgical treatment of primary lung cancer in middle lobe.Methods 123 patients diagnosed primary lung cancer in middle lobe were retrospectively studied.The diagnosis was made by CT of the thorax and bronchoscope. All patients were treated surgically.Results Right middle lobe lobectomy was performed in 32 patients,right middle sleeve lobectomy was performed in 5 patients,and right bilobectomy was performed in 86 patients.There were 58 cases of squamous cell carcinoma, 47 cases of adenocarcinoma,2 cases of adenosquamous carcinoma,4 cases of bronchioloalvelar carcinoma,8 cases of small cell carcinoma,and 4 case of carcinoid tumor.Conclusion Middle lobe was not the familiar location of primary lung cancer while the carcinoid tumor in this field was often seen in female.Because the tumors in the middle lobe often invade upper or lower lobe and metatsis to lobar nodes,bilobectomy is the suggested opertion method.Right middle sleeve lobectomy is dangerus because of the post operation complications. The adenocarcinoma metastasizes to brain,bone and pericardium earlier.