局部晚期非小细胞肺癌气管隆凸切除气道重建的临床分析

A Clinical Analysis Carina Resection and Reconstruction in Locally Advanced Non-small Cell Lung Cancer

目的探讨局部晚期非小细胞肺癌患者隆凸切除气道重建术的适应证,分析其临床特征和预后。方法回顾性分析我院15例气管隆凸切除气道重建肺癌手术患者的临床资料,其中单纯气管隆凸完全切除重建术1例,右全肺切除加隆凸切除重建术6例,右肺上叶切除加隆凸完全切除重建术3例,左全肺切除加隆凸切除气道重建术5例。采用Kaplan-Meier法计算生存率,采用Log-rank检验比较生存期。结果手术时间155～410min(261.3±81.6min),术中清扫纵隔淋巴结10.8±3.7枚。全部患者无围术期死亡;术后并发肺部感染2例,经呼吸机辅助通气加抗感染治疗后出院;乳糜胸1例,保守治疗后康复出院;1例患者因胸管持续Ⅱ度漏气而行开胸探查,术中发现是余肺而非气管吻合口漏气,缝扎肺组织漏气处痊愈。全组患者中位生存期为39个月,3年生存率52.5%,5年生存率22.5%。右全肺切除加隆凸重建患者中位生存期12个月,非右全肺切除患者中位生存期40个月。结论对侵犯主支气管近端及隆凸的局部晚期肺癌患者,肺切除加隆凸切除重建术可取得较为理想的治疗效果,但其中需行右全肺切除患者预后较差,采用手术治疗应慎重。

Objective To investigate the indication of carina reconstruction surgery for locally advanced non-small cell lung cancer through analyzing the clinicopathological characteristics and prognosis of these patients. Methods Fifteen patients were involved in this retrospective analysis. One patient underwent carina resection and reconstruction, 6 patients underwent right pneumonectomy plus carina resection and reconstruction, 3 patients underwent right upper lobe and earina resection plus carina reconstruction, and 5 patients underwent left pneumonectomy plus carina resection and carina reconstruction. Kaplan Meier method was used to calculate the survival rate, and Log-rank test was used to compare the survival difference between groups. Results The mean duration time for operation was 410 min （261.3±81. 6min）. The number of resected mediastinal lymph nodes was 10.8 ± 3. 7. No perioperative death occurred. Two patients complicated with pneumonitis after surgery, both of them recovered through machine supported respiratory combined with antibiotics administering; 1 patient complicated with chylothorax and recovered through non-invasive procedure; 1 patient underwent thoracotomy exploration due to the persistant air leak and cured by suturing the air leaking lung tissue. The median survival time for whole group was 39 months, 3-year and 5-year survival rate were 52.5%, 22. 5%, respectively. The median survival time for the patients underwent right pneumonectomy was 12 months, compared 40 months with that of other patients. Conclusion Carina reconstruction is necessary for some patients with locally advanced nowsmall cell lung cancer with main bronchus or carina invasion, despite the sophisticated operation procedure and high morbidity rate. While the right pneumonectomy plus carinal reconstruction should be avoided due to the poor prognosis.