气管隆凸切除与重建术在肺癌治疗中的应用

Tracheal and carinal resection and reconstruction in the treatment of lung cancer

背景与目的手术治疗侵犯隆凸的肺癌需要实施隆凸的切除与重建。本研究的目的是总结和探讨气管隆凸切除与重建手术治疗肺癌侵犯气管隆凸的方法和疗效。方法回顾性分析73例实行气管隆凸切除与重建术的肺癌患者,其中右全肺切除及隆凸切除22例,右全肺切除气管支气管成形14例,右全肺袖式切除12例,右上叶切除气管支气管成形15例,左全肺袖式切除2例,左全肺切除气管支气管成形8例。结果本组姑息性手术4例。手术近期死亡4例(5.48%)。手术后1年、3年和5年的生存率分别为75.3%、63.0%和23.3%。结论严格掌握手术适应证、精心作术前准备、选择适当手术方式和积极的围手术期处理可以提高手术的效果。

Background and objective Tracheal and carinal resection and reconstruction is an important way in treatment of lung cancer invading trachea and carina. The aim of this study is to summarize the method and effect of tracheal and carinal resection and reconstruction in treatment of lung cancer. Methods Seventythree patients with lung cancer who underwent tracheal and carinal resection and reconstruction were retrospectively analyzed. There were 22 cases for right pneumonectomy and carinal resection, 14 cases for right pneumonectomy and tracheobronchoplastie procedure, 12 cases for right sleeve pneumonectomy, 15 cases for tracheobronchoplastic procedure plus right upper lobectomy, 2 cases for left sleeve pneumonectomy and 8 cases for left pneumonectomy and tracheobronchoplastic procedure. Results Four cases received palliative operation. Four patients （5.48%） died in the perioperative period. The 1-, 3- and 5-year survival rate was 75.3%, 63.0% and 23.3% respectively. Conclusion Careful preoperative assessment, skillful operation and appropriate postoperative treatment are helpful to improve the outcome of tracheal and carinal resection and reconstruction for lung cancer.