肺癌袖状切除术与全肺切除术疗效比较分析

Comparative analysis of sleeve resection and pneumonectomy for lung cancer

背景与目的 肺癌袖状切除术可以达到与全肺切除相似的肿瘤和淋巴结切除率，而且，同全肺切除相比，可以减少肺功能的丧失，改善患者生存质量。该研究旨在比较肺癌患者肺癌袖状切除术和全肺切除术的5年生存率和术后并发症。方法 选取我院自1990年1月～2000年12月收治的173例肺癌袖状切除术和435例全肺切除术患者，回顾性分析两种手术方式的5年生存率，并比较其并发症发生率及围手术期死亡率的差别。结果 肺癌袖状切除术患者总的5年生存率为42．3％，全肺切除术为30．9％，前者生存期明显长于后者（P-0．007）；其中右侧肺癌行袖状切除术的患者5年生存率优于右全肺切除术[p-0．004（N0），0．025（N1），0．042（N0）]；左侧N0期肺癌袖状切除术后生存期明显优于左全肺切除（P=0．018），N1及N2期肺癌两种术式的5年生存率无差异；支气管肺动脉成形术与全肺切除术的生存期亦无显著性差异；肺癌袖状切除术后肺感染和心律失常并发症发生率低于全肺切除术（P-0．019），围手术期死亡率无显著性差异。结论 在可以选择袖状切除术或全肺切除术的肺癌患者中，右侧病变适合进行癌袖状切除术，而左侧病变无淋巴结转移者应首选癌袖状切除术，支气管肺动脉成形术与全肺切除术相比并未延长生存期。

Background and objective Sleeve recestion ior lung cancer can get similar tumor and lymph node resection rate as pneumonectomy, with less influence on pulmonary function and much improvement of quality of life. The aim of this study is to compare the 5-year survival and complications of sleeve resection and pneumonectomy for lung cancer. Methods Survival analysis was used to investigate the 5-year survival of 173 patients undergoing sleeve resection and 435 patients undergoing pneumonectomy from January 1990 to December 2000. Their complication and perioperative motality were also analyzed. Results The overall 5-year survival for sleeve resection and pneumonectomy was 42.3 % and 30.9 %, respectively （P= 0. 007）. 5-year survival of right lung sleeve resection was better than that of left lung [P=0. 004 （N0）, 0. 025 （N1）, 0. 042 （N2）]. In left lung cancer patients without nodal involvement, the survival after sleeve resection was better than that after pneumonectomy. There was no survival difference between N1 and N2 lung cancer patients. Survival was not significantly different for bronchoplasty and pulmonary arterioplasty and pneumonectomy. The incidence rate of pneumonia and arrhythmia for sleeve resection was less than those for pneumonectomy （P =0. 0019）, and no significant difference of mortality was observed between the two groups. Conclusion In lung cancer patients suitable for sleeve resection or pneumonectomy, sleeve resection should be performed for right lung cancer and left lung cancer of stage I Bronchoplasty and pulmonary arterioplasty don＇t prolong the survival of lung cancer patients compared with pneumonectomy.