31例同期双原发肺癌的手术方式和患者生存情况分析

Surgical Treatment and Prognosis of Synchronous Double Primary Lung Cancer: a Report of 31 Cases

背景与目的双原发肺癌(doubl eprimary lungcancer,DPLC)的概念已被普遍认可,近年来文献报道同期DPLC的发生率有所增加,然而其诊断标准和治疗原则尚待进一步完善。本文总结同期DPLC的手术方式和患者的生存情况。方法对中国医学科学院中国协和医科大学肿瘤医院胸外科1983年1月至2004年4月手术治疗的同期DPLC的发生情况、手术方式、术后并发症发生情况和患者的生存情况进行分析。结果全组同期DPLC患者共31例,占该时段我科手术治疗原发肺癌患者的0.67%(31/4649)。两个癌灶均行所在肺叶切除或全肺切除者12例,至少有一个病灶行局部切除者19例。术后并发症发生率为29%(9/31),包括呼吸功能不全1例、肺不张3例、房颤2例、反复咯血1例、胸腔积液1例、切口脂肪液化1例,无手术中及手术后30天内死亡。术后1、3、5年生存率分别为52%、29%、20%。结论同期DPLC发病率低,对同期DPLC患者采取积极、合理的手术治疗可以取得满意的疗效;术后并发症发生率低,部分患者可获长期生存。

BACKGROUND & OBJECTIVE: The idea of double primary lung cancer (DPLC) has been generally accepted. Recently, an increasing incidence of synchronous DPLC has been reported, while the diagnostic standard and treatment strategies remain to be improved. This study was to investigate effective surgical treatment, and prognosis of synchronous DPLC. METHODS: From Jan. 1983 to Apr. 2004, 31 patients with synchronous DPLC were operated in our department. Clinical data, such as surgical pattern, postoperative complication, and survival status, of all these patients were reviewed retrospectively. RESULTS: The 31 patients with synchronous DPLC accounted for 0.67% of all 4 649 patients operated for primary lung cancer in our department during the same period. Both tumors of synchronous DPLC were resected with lobectomy or pneumonectomy in 12 patients, while among the other 19 patients, at least 1 tumor was treated with partial pulmonary resection. The postoperative morbidity was 29% (9/31), including 1 case of respiratory insufficiency, 3 cases of atelectasis, 2 cases of atrial fibrillation, 1 case of haemoptysis, 1 case of pleural effusion, and 1 case of wound fat necrosis. No death occurred during operation or within 30 days postoperatively. The postoperative 1-, 3-, and 5-year survival rates were 52%, 29%, and 20%, respectively. CONCLUSIONS: The incidence of synchronous DPLC is low. Aggressive and reasonable surgical approach can achieve satisfactory outcomes in patients with synchronous DPLC. The postoperative morbidity is low. Some patients might achieve long-term survival.