袖状肺叶切除合并肺动脉或上腔静脉成形术治疗53例肺癌

Sleeve Lobectomy plus Arterioplasty of Pulmonary Artery or Angioplasty of Superior Vena Cava for Lung Cancer

目的:分析袖状肺叶切除合并肺动脉或上腔静脉成形术治疗肺癌的效果及探讨肺癌侵犯心包外肺动脉的分期定义。方法:回顾分析中国医学科学院肿瘤医院1981年9月～2007年1月间应用袖状肺叶切除同期施行肺动脉或上腔静脉成形术治疗肺癌的资料。全组男42例,女11例。年龄33～71岁,中位年龄59岁。根据肿瘤侵犯部位分为侵犯上腔静脉组和侵犯肺动脉组。根据术后病理淋巴结转移分为N0、N1、N2组。结果:53例肺癌患者接受了袖状肺叶切除合并肺动脉(共41例,其中13例肺动脉袖状切除术,28例肺动脉侧壁切除术)或上腔静脉成形术(共12例,其中9例为上腔静脉侧壁切除,3例为上腔静脉切除人工血管重建;其中袖状肺叶切除合并隆突成形及肺动脉和上腔静脉成形术3例)。全组并发症发生率15.1%(8/53),无手术死亡。全组5年生存率37.7%(20/53),肺动脉成形组5年生存率41.5%(17/41),上腔静脉成形组5年生存率25.0%(3/12)。术后病理N0组中位生存期26个月,N1组中位生存期24个月,N2组中位生存期10个月。3组之间生存率差异有统计学意义(P=0.002)。多因素分析发现:淋巴结转移是独立预后因素(P=0.007,RR=2.836,95%可信区间:1.330～6.049),而TNM分期(P=0.367)和组织学类型(P=0.679)不是独立的预后因素。结论:袖状肺叶切除合并肺动脉或上腔静脉成形术是安全的,并发症在可接受范围内。提高肺癌术后生存率的关键在于手术适应证的选择,即病理N0-1的病例。对于肺癌,手术前应该尽可能明确纵隔淋巴结的转移状况。肿瘤侵犯心包外肺动脉应定义为T2期。

Objective： To analyze the surgical results of sleeve lobectomy plus arterioplasty of pulmonary artery （PA） or angioplasty of superior vena cava （SVC） for lung cancer and to discuss the T grade of tumor invading extrapericardial PA. Methods： We retrospectively reviewed the data from 53 patients with lung cancer who received sleeve lobectomy plus arterioplasty of PA or angioplasty of SVC in our hospital from September 1981 to January 2007. There were 42 males and 11 femals, with a median age of 59 years （range 33-71）. According to the invading site, these patients were divided into two groups： the tumor invading superior vena cava group and the tumor invading pulmonary artery group. And according to pathological lymph node status, these patients were divided into three groups： N0, N1 and N2 group. Results： Of the 53 patients, 41 received sleeve lobectomy plus arterioplasty of PA （13 sleeve resection and 28 tangential resection）; and 12 received angioplasty of SVC （3 sleeve resection and 9 tangential resection）. The complication rate was 15.1%（8/53）. The 5- year survival was 38.5% for all of the patients, 42.9% for patients in the PA group and 22.2% for patients in the SVC group. Pathological lymph node status significantly influenced the survival period （10 months in N2 group, 24 months in N1 group, and 26 months in No group. P〈0.05）. Cox regression analysis showed that pathological lymph node status was an independent prognostic factor （P=0.002, RR=2.836, 95% CI：1.330-6.049）. Conclusion： For patients with lung cancer, lobectomy plus arterioplasty of PA or angioplasty of SVC can be accomplished safely and the postoperative complication rate is acceptable. Patients with pathological N0-1 lung cancer may benefit from surgical treatment. Before surgery, we should carefully evaluate the mediastinal lymph node status. Tumor invading extrapericardial PA should be defined as T2.