肺转移瘤的外科治疗(附106例报告)

Surgical management for pulmonary metastases(106 cases report)

目的：探讨肺转移瘤外科治疗的指征、术前评价、手术方法及影响预后的因素。方法：对１０６ 例肺转移瘤的临床资料进行回顾性分析。结果：经手术治疗的肺转移瘤１０６ 例，其中转移性癌８６ 例，转移性肉瘤２０ 例，二者５ 年生存率分别为１９ ．８％ 和２０％ 。以原发肿瘤乳腺癌、头颈部癌、泌尿系癌及骨肉瘤的肺转移预后较好，５ 年生存率分别为３３ ．３ ％ 、２７ ．３ ％ 、２０ ％ 及３３ ．３ ％ 。全组１ 年、３ 年、５ 年和１０ 年生存率分别为８３ ％ 、３５ ．８ ％ 、９．８ ％ 和６ ．６ ％ 。术后行跟放／ 化疗者的５ 年生存率为１８ ．１ ％ ，未行者２３ ．５ ％ ，二者间差异不显著。全组并发症的发生率为４．２ ％ ，无手术死亡。结论：对原发肿瘤已达根治，无他处转移及肺功能可承受手术者作为手术指征；手术途径以病侧后外切口为主；探查时应避免遗漏多发转移灶，遵循最大限度切除肺转移瘤及保留正常肺组织的原则；重视前瞻性的术后辅助治疗，以期提高手术疗效。

Aim:To review the experience of surgical treatmen tof pulmonary metastased.Clinical material and method:From 1961 to 1997,118 resections for pulmonary metastases were performed in 106 patients,86 with carcinoma and 20 with sarcoma. The surgical procedures included 73 wedge resections,44 lobectomies and 1 pneumonectomy.Result:The surgical morbidity was 4.2%,and there was no operative mortality.The overall 5-year survival rate was 19.8% for patients with carcinoma,and 20% for those with sarcoma.For various sites of primary malignancies their 5-year survival was quite different.The better outcomes ranged in the groups of metastases from breast cancer,head and neck carcinoma,urinary tract cancer and osteosarcoma,which were 33.3%,27.3%,20%,and 33.3%,respectively.The 5-year survival for metastases from melanoma,oesophageal and gastric cardiac carcinoma was very poor. Conclusion:We emphasize the importance of a thorough evaluation for metastases,an strict indication in selecting patients,and a careful exploration.The combination of several significant individual factors was the best indicator for evaluating the postoperative long-time survival.A planned postoperative adjuvant chemotherapy and/or radiotherapy would play a more important role in the treatment of pulmonary metastases.