全肺切除治疗肺癌115例报告

A report on pneumonectomy in 115 cases of lung cancer.

目的 总结我科近十年来全肺切除 115例经验。方法 右侧全肺切除 17例 ,左侧全肺切除 98例 ,经心包全肺切除 38例。按 TNM分期 : 期 13例 , a期 46例 , b期 5 6例。病理分型 :非小细胞肺癌 99例 ,小细胞肺癌 16例。结果 手术死亡 1例 ,3例术后胸腔内出血 ,1例因心包缝合过紧 ,术后出现心脏压塞。 10例术毕施行了预防性气管切开 ,术后 13例早期应用人工呼吸器治疗。晚期并发脓胸 7例 ,5例发生支气管胸膜瘘。结果 1年生存率 5 8.4% ,3年生存率 32 .9% ,5年生存率为 18.6 %。小细胞肺癌 16例 ,无 1例生存到 3年。结论 肺癌就诊多属晚期 ,但临床 期病例 ,只要肺功能耐受 ,应选择根治性全肺切除。

Objective To review the experience on pneumonectomy for 115 patients in the authors′ department.Methods From 1989 to 1999,17 patients underwent right pneumonectomy,98 patients underwent left pneumonectomy,and 38 patients underwent pneumonectomy via pericardium.According to the TNM classification,13 patients were in phase Ⅱ,46 patients in phase Ⅲa and 56 patients in phase Ⅲb.There were 99 cases of non small cell carcinoma and 16 cases of small cell carcinoma.Results One patient died in the immediate postoperative period.Early complications included hemathorax in 3 patients and cardiac tamponade in one patient on account of too-tight suture of precardium.10 patients were subjected to preventivetracheotomy after operation and 13 patients were treated with the help of respirator early after operation.In late postoperative period,7 cases were complicated with empyema and 5 cases developed bronchopleural fistula.Of the 115 patients,the 1 year survival rate was 58.4%,3 year survival rate 32.9%,and 18.6% patients survived over 5 years.In all of the 16 patients with small cell carcinoma,no one survived more than 3 years.Conclusion Most of the patients with lung cancer were in advanced stage when they went to hospital;for those in phase Ⅲ,radical pneumonectomy was the choice on condition that the patients′ lung functions were good enough for the operation.