肺癌侵犯大血管的外科处理

Surgical management of lung cancer involving big vessels

目的探讨大血管成形术在肺癌外科中的应用价值。方法回顾性分析136例肺癌手术中涉及大血管成形术患者的病例资料。TNM分期Ⅱb29例;Ⅲa45例;Ⅲb62例。鳞状细胞癌98例,腺癌31例,小细胞肺癌7例。结果136例中上腔静脉置换或部分切除术18例,血管旁路分流术4例;肺动脉成形术92例,其中右上叶肺动脉袖状切除2例,部分切除12例,左上叶袖状切除14例,部分切除64例;左心房部分切除22例。无手术死亡者,随访结果满意。结论应用大血管成形术可以提高手术切除率及手术的安全性,可以最大限度地保留患者的肺功能,并有助于提高患者的术后生存率及生活质量。

Objective To evaluate the clinical application of angioplasty in surgical treatment of lung cancer. Methods The data of 136 lung cancer cases undergoing great vessels angioplasty while surgical procedure in Department of Thoracic Surgery, China-Japan Friendship Hospital from 1983 to 2004 were analyzed. Results Among 136 cases, 18 cases had superior vena cava artificial vessel replacement and superior vena cava partial resection; 4 cases had a shunt between superior vena cava and right auricle. 92 cases of pulmonary artery arterioplasty were performed. 2 cases had sleeve resection of right upper lobe pulmonary artery, 12 cases had partial resection; 14 cases had sleeve resection of left upper lobe pulmonary artery, 64 cases had partial resection. 22 cases of partial left atrium resection were performed. No perioperative mortaliy occurred in this group and the results of follow up were satisfactory. Conclusions The operative rate and safety of operation can be improved with the application of angioplasty. Pulmonary function of patients can be reserved maximally; The post-operative survival rate and living quality can be also improved with the application of angioplasty.