肺肿瘤再次手术治疗分析

Analysis of reoperation in lung neoplasm

目的探讨再次肺切除治疗肺癌及胸膜肿瘤肺浸润的价值。方法回顾6例肺癌及1例胸膜肉瘤肺浸润患者再次手术治疗的资料,分析手术难度及术后恢复情况并总结治疗经验,随访分析全组病例生存情况。结果除胸膜肉瘤外其余6例肺癌患者均为完全切除病灶,无术中及围术期死亡。7例胸膜粘连均严重,尤其肺门处肿瘤生长、浸润严重,3例患者肺门大血管破裂出血500 ml以上。手术时间和术中出血量明显超出初次手术(P=0.000)。术后发生心、肺功能不全各1例,短期支气管胸膜瘘、伤口感染各1例。全组1年、2年生存率分别为42.9%和14.3%,肺癌组1年、2年生存率分别为50.0%和16.7%。结论虽然肺部肿瘤再次手术的难度和风险增大,但其成功率仍然很高,只要掌握好手术指征再次手术仍然能够获得满意疗效。

Objective To investigate the value of re-excision in lung cancer and pleural tumor infiltrating lung after the first operation. Methods Reviewed the clinical record of 6 cases with lung cancer and 1 case with pleural sarcoma infiltraing lung who had all undergone lobectomy. Analysed the operative difficulties and postoperative restoration, and summarized treatment experiences. Results Except the case with pleural sarcoma ,6 eases with lung cancer received complete excision of tumors, and none of these cases died in operation procedure or during perioperation. Pleural adhesion was serious in 7 cases, especially to hilum of lung with serious tumor infiltration, and 3 cases, hemorrhage was more than 500 ml. The operation time and hemorrhage were beyond that of the first operation significantly （P = 0. 000）. There were 1 case with cardiac insufficiency, 1 case with hypopnoea, 1 case with temporary bronehopleural fistula and 1 case with incision infection postoperatively. To the whole group,survival rate of 1 year and 2 years was 42. 9% and 14. 3% respectively; to the lung cancer group, survival rate of 1 year and 2 years was 50. 0% and 16.7% respectively. Conclusions Notwithstanding the higher difficulty and risk, the achievement rate of re-excision in lung cancer and pleural tumor is high. As long as the indicatio is exactly grasped by doctors, this operation can also bring satisfactory effect.