隆凸成形术治疗中心型肺癌41例

Experience of carinal resection and reconstruction in the treatment of carinal tumor and bronchogenic carcinoma

背景与目的 对累及隆凸中心型肺癌实施隆凸成形术一直是普胸外科研究的难点。本研究拟探讨隆凸成形术在肺癌外科中的应用价值。方法 总结1982～2004年41例中心型肺癌侵犯隆凸的外科治疗资料。41例均行隆凸成形术，其中25例同时行心脏大血管切除，手术采用12种不同类型的隆凸切除重建方式。结果 全组围术期死亡1例（原因为吻合口瘘），术后并发症为各种心律失常12例、肺不张6例、肺部感染5例。呼吸功能衰竭行呼吸机辅助通气5例。本组1、3、5年生存率分别为76．21％、47．23％、26．83％。结论 对侵犯隆凸的中心型肺癌应用隆凸成形术治疗，可以最大限度地切除肺癌组织，最大限度地保留患者的肺功能，术后多学科治疗能提高患者的术后生存率和生活质量。

Background and objective Carinal resection and reconstruction is an emphasis in surgical treatment of carinal tumor and bronchogenic carcinoma involving carina. The aim of this study is to discuss the clinical value of carinoplasty in lung cancer surgery. Methods From 1982 to 2004, 41 cases of central bronchogenic carcinoma that invaded the carina accepted carinal resection and reconstruction in this hospital. Of the 41 patients, 25 patients underwent simutaneously additional cardiovascular plasty operation besides carinoplasty. There were 12 different types of carinal resection and reconstruction in this series. Results There was 1 perioperative death （because of anastomotic leakage） in this group. Arrhythmia occured in 12 patients, atelectasis in 6 patient and pneumonia in 5 patients. Five patients were assisted ventilation through breathing machine because of pulmonary function failure. The 1-, 3-, and 5-year survival rates were 76.21%, 47.23% and 26.83% respectively. Conclusion The carinoplasty is a good method to treat central bronchogenic carcinoma which invaded the carina. With this method lung cancer tissue can be resected maximally, meanwhile, it can save pulmonary function of patient maximally. Postoperative multi-modality therapy is helpful to increase postoperative survival rate and improve quality of life.