同时支气管肺动脉联合成形术治疗中央型肺癌

Sleeve resection of bronchus and pulmonary artery for central type lung cancer

背景与目的：近年来支气管肺动脉联合成形术愈来愈广泛的应用于肺功能不佳的肺癌患者中，该术式符合最大限度地切除肺癌和最大限度地保留肺功能的肺癌手术原则，该项手术技术有着很好的前景。我们总结近年来采用支气管肺动脉联合成形术治疗中央型肺癌的体会来探讨该项手术的应用指征和方法。方法：1993年12月-2003年12月，对63例中央型肺癌施行支气管肺动脉联合成形肺叶切除，包括支气管肺动脉双袖状切除术43例，其中右肺上叶袖切＋肺动脉袖切20例；左肺上叶袖切＋肺动脉袖切23例；切除肺动脉的长度为1．5～4．5cm，平均2．5cm．支气管肺动脉双禊形切除术3例；其中右肺上叶禊切＋肺动脉楔切2例；左肺上叶楔切＋肺动脉楔切1例。支气管袖切并肺动脉禊切17例，其中右肺上叶袖切＋肺动脉楔切5例；左肺上叶袖切＋肺动脉禊切12例。结果：本组无死亡及吻合门瘘发生：结论：支气管肺动脉联合成形术使肺癌手术指征扩大，符合最大限度地切除肿瘤及最大限度保留肺功能的肺癌手术基本原则，是一种安全、有效、可行的术式。

Background and purpose： In recent years, sleeve resection of bronchus and pulmonary artery has been more extensively applied in treatments of lung cancer patients with poor pulmonary functions. This kind of surgery meets the basic surgical principles of lung cancer being maximum bottl in resectiug the carcinoma of the lungs and preserving puhnonary functions, has a good prospect. Therefore, we summarize our recent experience in treating central type lung cancer by this method and discuss its principles and methods in the application of the surgical operation. Methods： From Dee. 1993 to Dec. 2003, 63 patients with central type lung cancer underwent sleeve lobectonly of bronchus and pulmonary artery, including sleeve resection of bronchus and pulmonary artery in 43 cases, wedge resection of bronchus and pulmonary artery in 3 cases, sleeve resection of broncllus and wedge resection of pulmonary artery in 17 cases. The surgical procedures of sleeve resection included sleeve resection of right upper lobe and puhuonary artery in 20 cases, sleeve resection of left upper lobe and pulmonary artery in 23 cases, and the length of pulmonary artery that had been respected is from 1.5cm to 4.5cm, the average length is 2.5cm. The surgical procedures of wedge resection included wedge reseetion of right upper lobe and pulmonary artery in 2 cases, wedge resection of left upper lobe and pulmonary artery in t ease. The group of sleeve resection of bronchus with wedge resection of pulmonary artery included slee,,e resection of right upper lobe and wedge resection of pulmonary artery in 5 cases, sleeve resection of left upper lobe and wedge resection of pulmonary artery in 12 eases. Results： No ease of death and anastomutie leak occurred. Conclusions： Because sleeve resection of bronchus and pulmonary artery can not only eftectively reseet the tumor but also maximally presene the pulmonary function at the same time, it enlarges the surgieal indieations of lung cancer, and is an effective and safe method for the treatment of lung cancer.