单侧肺循环短暂阻断术在局限性T_4期肺癌外科治疗中的应用

Transient blocking of both pulmonary artery and veins for surgical treatment of stage Ⅲ central lung cancer

目的探讨同期阻断肺动脉、肺静脉的单侧肺循环短暂阻断术在局限性 T_4期肺癌外科治疗中的应用价值。方法开胸后首先探查肺癌、转移淋巴结与肺血管的关系,如果肺动脉干受侵,在心包内或心包外游离出患侧肺动脉干根部和上、下肺静脉,放置血管阻断钳同时阻断,防止肺动脉和左心房血液逆行倒灌出血。在患侧肺循环无血状态下切除病肺和受肺癌侵犯的部分肺动脉。行肺动脉成形或吻合后,开放阻断的肺动脉干和保留肺静脉,恢复肺循环。结果肺动脉、肺静脉分别阻断(46.0±2.5)min 和(35.0±1.5)min。20例侵犯肺动脉的局限性T4期肺癌切除率为100%,均保留了健康有功能的上叶肺或下叶肺,避免了全肺切除。术中平均出血量256 ml。3例双袖切的病人术后出现因痰阻塞支气管的肺不张,经吸痰后治愈。3例出现心律失常,经对症处理后好转。结论同期阻断肺动脉、肺静脉的肺循环短暂阻断术,为不能耐受全肺切除的局限期 T_4期肺癌病人保留了健康肺组织,提供了一种安全、简捷的新手术方法。

Objective To investigate the feasibility of transient blocking of both pulmonary artery and veins for surgical treatmeet of central lung cancer with stage m to preserve the normal pulmonary. Methods Firstly, the relation of the pulmonary artery, the lung neoplasm and the enlargedmediastirml lymph nodes was investigated. If the hilum of lung remained frozen, the pericardium was opened and the pulmonary artery, the upper and lower lobe pulmonary veins were dissected. Then those three vessels were blocked. When the pulmonary circtdation was stopped, bloodless lobectomy and pulmonary artery angioplasty and/or anastomo6is were performed. Then the blockers were released, and pulmonary circtdation was restored. The time of blocking was （35 ± 15 ） minutes （16±66minutes）. Results All 20 patients suffer from stage Ⅲ central lung cancer , whieh＇sthehilaoflungremained frozen, received ecocom complete resection of the tumor. The normal functioning ixdmonary tissue in the 20 patients was preserved instead of pneunonectomy. The average amount af bleeding was 256 ml （ 180 ± 420 ml） during operation. All 20 patients recovered well. Conclusion Transient blocking of bolh pulmonary artery and veins for surgical treaanent of stage Ⅲ central lung cancer is and innovation in surgical technique, which makes the operation safe and easy. This technique may provide a chance to patients, with poor cardio-pulmorary function. In addition, this technique widens the surgical indications for patients suffering from lung cancer.