210例肺癌全肺切除临床分析

Pneumonectomy for 210 cases of lung cancer

目的:总结全肺切除术治疗肺癌的临床经验,探讨肺癌全肺切除的治疗价值。方法:对210例肺癌患者进行全肺切除术,其中男169例,女41例,平均年龄54.77岁,包括左全肺切除144例,右全肺切除66例,其中心包内处理血管全肺切除26例,下腔静脉成型术1例,隆突成型术1例。支气管残端均采用手工缝合,常规进行系统淋巴结清扫。结果:本组无术中死亡,术后30d内59例(28.10%)发生并发症,9例(4.28%)死亡;除外死亡病例,术后总的1,3和5年生存率分别为66.21%,36.13%和24.26%。小细胞肺癌12例,仅1例生存满3年。结论:全肺切除术后并发症的发生率及病死率均较高。慎重合理地选择手术病例,加强术后监测及围手术期处理,配合放、化疗,全肺切除仍是治疗肺癌的一种有效的方法。

Objective To summarize 210 cases of lung cancer that underwent pneumonectomy, and to study the therapy value of pneumonectomy for lung cancer. Methods Between January 1993 and December 2004,210 patients （169 males and 41 females ） with lung cancer underwent pneumonectomy in our hospital with the mean age of 54.77 years. Out of the 210 cases 144 had left pneumonectomy, and 66 had fight pneumonectomy. Among them, 26 experienced intrapericardial pneumonectomy, 1 inferior vena cava reconstruction, and 1 carina reconstruction. All bronchial stumps were closed by manual suture, and systemic node dissection was performed routinely. Results No one died during the operation, but 59 patients （28.10 % ） experienced postoperative complications and 9 patients （4.28%） died within 30 days of operation. After exclusion of postoperative deaths, the 1-year,3-year, and 5-year survival rates were 66.21% ,36. 13% and 24.26% , respectively. Only 1 out of the 12 patients with small cell carcinoma survived more than 3 years. Conclusion Mortality and morbidity were high in pneumonectomy. If we carefully and properly select the patients, enhance postoperative monitoring and perioperative treatment, and combine with chemoand/or radiotherapy, pneumonectomy will surely be effective for patients with lung cancer.