闭合器辅助下扩大左房切除术治疗局部晚期肺癌的手术探讨

Advanced Lung Cancer Invading the Left Atrium Wall Treated with Pneumonectomy and Lobectomy and Combined Resection of Left Atrium Using Stapling Devices

【目的】探讨侵犯左房壁的局部晚期肺癌患者行扩大左心房切除术的临床疗效。【方法】24例侵犯肺静脉根部及左心房壁的肺癌患者，在心耳钳辅助下行扩大左心房壁切除8例；体外循环辅助下行扩大左心房壁切除5例；在闭合器辅助下行扩大左心房壁切除11例。手术中同时切除相应肺或肺叶切除。【结果】在心耳钳辅助下行扩大左心房切除术中，有1例患者死亡，术后发生并发症2例次；体外循环辅助下行左心房壁切除术患者无死亡，术后发生并发症5例次；闭合器辅助下行扩大左心房壁切除术患者无死亡，术后发生并发症3例次。所有患者术后随访，平均26（6～48）个月，1年生存率83．3％，2年生存率63．3％。【结论】对于侵犯肺静脉根部及左房壁的局部晚期肺癌，在闭合器辅助下行扩大左房切除术，避免术中使用体外循环技术，既保障手术安全，又减轻手术创伤，具有良好的手术效果。

[Objective]To discuss the surgical method about advanced lung cancer invading the left atrium wall treated with pneumonectomy and lobectomy and combined resection of left atrium. [Methods]Twenty four cases of advanced lung cancer invading the left atrium wall were treated with pneumonectomy and lobectomy and combined resection of left atrium using vessel pincers（ n = 8）, cardiopulmonary bypass（CPB）（ n = 5） and stapling devices（ n = 11）respectively. [Results]There were one operative death and two complications on postoperation using vessel pincers assistance; there were no operative death but five complications on postoperation in using cardiopulmonary bypass,there were no death but three complications by stapling devices. All patients were followed up, mean follow-up time was 26（6-48） months, the survival rate in 1 year,2 years was 83. 3%,63.3% respectively. [Conclusion]Using stapling devices in extended lung resection for lung cancer invading left atrium can assure surgical security compared to using vessel pincers and simplify operative procedures, decrease surgical trauma compared to using CPB.