支气管、隆凸及肺血管成形术治疗中央型肺癌92例临床分析

Bronchial Sleeve Lobectomy and Carinal Resection in the Treatment of Central Lung Cancer: A Report of 92 Cases

背景与目的外科手术是早、中期非小细胞肺癌的首选治疗方案。本文总结支气管袖状、隆凸切除及支气管肺动脉双袖状成形术等手术方式治疗92例中央型肺癌的临床经验。方法对我院1996年1月-2010年5月间92例中央型肺癌患者施行以支气管袖状成形术为主的多种切除重建手术。其中右肺上叶支气管袖状切除术49例,左肺上叶袖状切除术14例,右肺中叶袖状切除术3例,左肺下叶袖状切除术4例,左肺支气管肺动脉双袖状成形肺叶切除术8例,右肺上叶切除合并器官隆凸切除重建3例,全肺切除合并气管隆凸切除重建术7例,主气管袖状切除4例。结果无围手术期死亡病例,平均手术时间2h43min,平均失血415mL,术后肺不张7例(7/92),声音嘶哑4例(4/92),机械通气支持3例(3/92)。1年、3年、5年生存率分别为80.7%、59.6%、31.5%。结论隆凸切除、支气管袖状成形术、支气管肺动脉双袖状成形术等术式既能最大限度地切除肿瘤,又能最大限度保护了肺功能,且隆凸切除气道重建术能进一步扩大手术适应症,提高了中央型肺癌的手术切除率。

Background and objective Surgery is the best treatment for early and middle stage non-small cell lung cancer.The aim of this study is to summarize the experience of bronchial sleeve mordality lobectomy and carinal resection in the treatment of 92 patients with central lung cancer from January,1996 to May,2010.Methods A total of 92 patients with central lung cancer underwent pulmonary resection.Carinal resection and reconstruction were performed in 14 patients,bronchial sleeve resection in 70 patients,and bronchial sleeve combined with pulmonary artery sleeve lobectomy in 8 patients.Results There was no operative mortality.The average operation time was 2 hours and 43 minutes.Postoperative complications such as pulmonary atelectasis occurred in 6.94% （7/92） of total group,and hoarseness in 4.35% （4/92）.The 1,3 and 5 year survival rates were 80.7%,59.6% and 31.5%.Conclusion Bronchial sleeve lobectomy and double sleeve lobectomy are capable of excising pulmonary tumor as much as possible while remaining healthy lung tissues.Carinal resection and reconstruction is helpful to extend the surgical indication,and increase the chance of successful resection.