隆突切除术治疗恶性肿瘤9例临床体会

The clinical experience of carinal resection for malignant tumor in 9 patients

目的总结9例隆突切除术治疗恶性肿瘤的经验体会。方法我科自1994年至2005年6月共施行隆突切除术9例，男7例，女2例，年龄35-62岁，平均52．6岁。行隆突切除、左主支气管气管端端吻合、右主支气管气管侧壁吻合术2例，右全肺隆突切除、左主支气管气管端端吻合术3例，右上肺隆突切除、左主支气管气管端端吻合、右中间支气管左主支气管侧壁吻合术1例，左全肺隆突切除、右主支气管气管端端吻合术2例，右侧半隆突切除、右主支气管气管端端吻合术1例。结果本组9例患者无术中死亡。无气管吻合口瘘和出血等并发症。1例并发肺部感染行呼吸机辅助通气治疗后死亡。2例患者术后出现ARDS予呼吸机辅助通气治疗。其中1例死亡。死亡率为2／9。结论隆突切除术虽然手术创伤大。并发症发生率较高。但只要严格掌握手术适应证，熟练手术技巧，术后积极防治并发症，仍不失为治疗侵犯隆突的恶性肿瘤的一种重要方法。

Purpose To review clinical experience of carinal resection to treat malignant tumor. Methods Between 1994 and June 2005,9 patients were performed carnial resection in our department. They were 7 males and 2 females with a mean age of 52.6 years（range from 35 to 62 years）. Two patients underwent carinal resection, end-to-end anastomosis of left main bronchus and trachea plus end- to-side anastomosis of right main bronchus and trachea; 3 underment right carinal pneumonectomy plus end-to-end anastomosis of left bronchus and trachea; 1 underment carinal resection plus right upper lobectomy, end-to-end anatomosis of left bronchus and trachea plus end-to-side anatomosis of right intermediate bronchus and trachea; 2 underment left carinal pneumonectomy plus anastomosis of right main bronchus and trachea; 1 underment right semi-carinal resection plus end-to-end anastomosis of right main bronchus and trachea. Results There was no death during the operation, no fistula of anastomosis and no bleeding postoperatively. One patient died of server pulmonary infection postoperatively after mechanical ventilation; and 2 patients developed ARDS, 1 of whom died though mechanical ventilation was given. The mortality was 2/9. Conclusions Carinal resection is an important treatment for malignant tumor involving the carina if the operation indication is restrictedly controlled, the operation technique is skilled and the postoperative complications is prevented actively, though it is a procedure with more trauma and more comorbities.