肺及左心房部分切除治疗局部晚期肺癌

Pulmonary Resection Combined with Partial Resection of Left Artrium in the Treatment of Locally Advanced Lung Cancer

目的总结左心房部分切除术对局部晚期肺癌的临床疗效。方法1997年7月至2007年2月,对33例肿瘤累及左心房的局部晚期肺癌行手术治疗。术中采用心耳钳钳夹左心房壁,在距肿瘤边缘0.5～1cm处切除部分左心房壁,其中3例联合切除部分食管肌层,整块切除肺肿瘤。左心房切缘用3-0无损伤线或5-0普罗纶线连续来回缝合。术前诱导化疗11例,术后化疗23例,其中1例联合放疗。结果术后心律失常3例,其中伴有心肺功能不全1例。无手术死亡,全组病例均治愈出院。术后病理检查:鳞癌17例,小细胞癌10例,小细胞癌伴鳞癌1例,腺癌3例,腺鳞癌1例,未分类1例。术后1、3、5年生存率分别为78.6%(22/28)、38.9%(7/18)和45.5%(5/11)。结论肺切除加左心房部分切除治疗局部晚期肺癌具有较好的临床疗效。

Objective To review the clinical result of pulmonary resection combined with partial resection of left artrium in the treatment of locally advanced lung cancer involving left artrium. Methods From July, 1997 to February,2007,33 patients with locally advanced lung cancer involving left artrium were treated by surgical resection. Of the 33 patients,21 were treated by pneumonectomy（ 13 left,8 right） combined with partial resection of left artrium,and 12 were treated by lobectomy or bronchial sleeve lobectomy and partial resection of left artrium. 3 patients were also treated by combined partial muscle resection of esophagus. 11 patients recieved preoperative chemotherapy and 23 cases received postoperative chemotherapy. Postoperative chemotherapy combined with radiotherapy was given to only 1 patient. Results There were 10 patients with small cell lung cancer, 17 patients with squamous cell carcinoma,3 patients with adenocarcinoma, and 1 patient with adenosquamous carcinoma. 1 patient had small cell lung cancer combined with squamous cell carcinoma, and 1 patient had carcinoma whose pathological type could not be successfully confirmed. No surgery related death occurred. Postoperative arrhythmia occurred in 3 cases, one of which had also cardiopulmonary insufficiency. The postoperative survival rate of 1,3 and 5 year was 78.6% （22/28） ,38.9% （7/18） and 45.5 % （5/11 ） respectively. Conclusion Pulmonary resection combined with partial resection of left artrium can obtain a good effectiveness in the treatment of locally advanced lung cancer involving left artrium.