肺转移瘤的外科治疗

Surgical management for pulmonary metastasis

目的 探讨肺转移瘤外科治疗的适应证、手术方式以及预后的影响因素。方法 对10 8例接受手术治疗的肺转移瘤患者的临床资料进行回顾性分析。结果 本组患者的 1,3,5 ,7及 10年生存率分别为 87.9%、4 7.3%、31.7%、2 3.7%和 13.9% ,中位生存期为 34.8个月。无瘤间歇期(DFI) >36个月、单个结节、无肺外转移和行开胸手术者预后较好 ,而年龄、性别、症状以及原发病理类型对预后均无影响。结论 对于有适应证的肺转移瘤患者应积极手术治疗 ,并以开胸手术为宜。对于DFI较短、转移灶数目较多的患者 ,手术应慎重。

Objective To investigate the indications of resection for lung metastasis, the surgical procedure and factors affecting the survival based on our experience accumulated for 37 years. Methods A total of 108 patients with pulmonary metastasis was treated by surgery. Pathology showed 93 carcinoma (86.1%) and 15 (13.9%) sarcoma. Totally 122 operations were performed: partial lung resection 51, segmental lobectomy 7, lobectomy 40, pneumonectomy 15. Results After surgery, the cumulative 1 , 3 , 5 , 7 and 10 year post thoracotomy survivals were 87.9%, 47.3%, 31.7%, 23.7% and 13.9%, with an overall median survival of 34.8 months. Solitary lesions, disease free interval (DFI)>36 months, absence of extrathoracic disease and 'open' thoracotomy were predictors of a longer survival whereas age, gender, symptom and pathology of the primary tumor were found statistically insignificant prognostic factors. Conclusion Surgery should be undertaken for patients who do fulfill these criteria, and 'open' thoracotomy is a better choice. Surgical treatment for patients with short DFI and multiple lesions should be attempted with prudence.