支气管肺动脉成形术治疗中心型支气管肺癌

Bronchoplasties and pulmonary arterioplasties in the treatment of central-type bronchogenic carcinoma

背景与目的 血管成形术或血管、支气管双成形肺叶切除术已广泛应用于心肺功能储备差、不能耐受全肺切除的局部晚期肺癌患者。本文旨在总结近年来在肺癌手术中应用肺动脉支气管成形技术的体会，讨论手术适应症选择、术中具体方法、肺动脉重建等问题。方法 从1999年10月～2005年10月对26例中心型肺癌累及肺动脉患者施行肺动脉成形或肺动脉支气管双成形肺叶切除术，并最大限度地切除肺癌以最大限度地保留肺功能。结果 全组无手术死亡。术后2例出现肺不张，2例并发肺感染，1例肺再灌注损伤。全组术后1年生存率为100．0％，3年生存率为69．2％。结论 血管成形术或血管、支气管双成形肺叶切除术可达到与全肺切除同样的效果，特别适用于心肺功能储备差、不能耐受全肺切除的局部晚期肺癌患者。

Background and objective The extent of pulmonary resection is decided by the location and extent of the tumor and the patient＇s physiologic ability to tolerate resection. Bronchoplastic and pulmonary arterioplastic procedures have become increasingly popular in recent years as an alternative to pneumonectomy. In this article our experience with arterioplastic and bronchoplastic procedures in the treatment of central-type bronchogenic carcinoma was reviewed. Methods From October 1999 to October 2005, 12 pulmonary arterioplasties and 14 combined broncho-angioplasties were performed for bronchogenic carcinoma and meanwhile two replacement of vena cava were done. Results Of the 26 patients, 18 were in stage Ⅱ and 8 were in stage Ⅲ. No fatal surgical complications occured. Atelectasis occurred in 2 patients （7.7 %）, postoperative pneumonitis in 2 （7. 7%）, and reperfusion lung injury in one （3. 8%）. The 1- and 3- year survival rates for the entire group were 100.0% and 69.2% respectively. Conclusion Pulmonary arterioplastic and broncho-angioplastic procedures can be performed safely. Angioplastic and combined broncho-angioplastic procedures offer patients with bronchogenic carcinoma similar a long-term result as radical lung resection, especially in patients who cannot tolerate pneumonectomy due to poor cardiopulmonary reserve.