外科综合化疗治疗小细胞肺癌的初步探讨

THE COMBINED TREATMENT WITH SURGERY AND CHEMOTHERAPY:PRIMARY APPROACH TO SMALL CELL LUNG CARCINOMA (SCLC)

报告４０例小细胞肺癌进行外科综合治疗的初步探讨。其中男性２８例，女性１２例；年龄２７～６６岁。咳嗽、血痰、低热、胸痛为主要临床表现。纤维支气管镜检查及病理报告均为小细胞未分化腺癌。单叶切除２０例，上（下）叶及中（舌）叶切除９例（含叶支气管袖状切除３例），全肺切除７例，经心包全肺扩大切除术２例，无法切除行肺动脉置入化疗泵管２例。术后病理分期Ⅰ期２例，Ⅱ期１８例，Ⅲａ期２０例。手术＋化疗１２例，化疗＋手术＋化疗２８例。化疗方案用阿霉素（或顺铂）、环磷酰胺、长春新碱、地塞米松。手术＋化疗组及化疗＋手术＋化疗组１、３、５年生存率分别为７０％、４５％、３０．５％和５４％、３０％、２２％。上述生存率比较显示，小细胞肺癌术后化疗可提高长期生存率。术前化疗对提高手术切除率具有显著作用，本组经术前化疗后的手术切除率为９３％。

Abstract Forty cases of small cell lung carcinoma (SCLC)treated with surgical and chemotherapeuticcombined therapy were reported.There were 28 males and 12 females in the group,most withhistory of more than 2 months,ranging in age of 27～66 years old.Cough,bloody sputum,lowfever and chest distress are the main clinical manifestation.The small cell undifferentiated carcinoma was confirmed by fiberbronchoscope examination and pathology in all patient.Single lobectomywas performed in 20 cases,lobectomy of the upper and middle lobe in 9 cases,(sleeve resection ofthe lobarbronchus in 3 cases),and total pneumonectomy in 7 cases.Two cases were of stage Ⅰ,18 were of stage Ⅱ,and 20 were of stage Ⅲa.Twelve patients received chemotherapy af-ter operation,and 28 patients underwent the“chemotherapy-operation-chemotherapy” treatmentmodle.Adriamycin (or CDDP),cytoxan,vincristin,and dexomathasone were used for thechemotherapy procedure.The 1,3,5-year survival rate of chemotherapy after operation andchemotherapy-operation-chemotherapy group were 70%,45%,30.5% and 54%,30% and 22%,respectivel It is demonstrated that the long-term survival rate could be elevated in SCLC patients treatedwith chemotherapy after surgical operation,and the chance of operation also could be elevated bypreoperative chemotherapy.The resection rate was 93% in the preoperative chemotherapy group.