应用自体肺重植技术治疗上叶中心型肺癌

Lung autotransplantation technique in the treatment for central lung cancer of upper lobe

目的 探讨应用自体肺重植技术治疗上叶中心型肺癌的可行性。方法 2例作双袖状右上中叶联合肺叶切除 ,因主支气管或肺动脉切除过长 ,吻合张力过大 ,遂切断下肺静脉 ,肺短时间离体后作下叶重植 ,将下肺静脉移植在上肺静脉残端。 2例左上叶肺癌部分侵及斜裂 ,无法进行双袖状肺叶切除术 ,作全肺切除后 ,在器械台上行肿瘤切除 ,将修剪后的下叶肺组织重植。结果 随访至 2 0 0 0年 2月 ,2例病人已分别无瘤存活 33和 2 0个月 ,生活质量良好。 1例术后 19d死于支气管胸膜瘘、张力性气胸 ;另 1例术后 42d因肺动脉、支气管胸膜瘘 ,作重植肺切除 ,术后 14个月死于肺部感染所引起的呼吸衰竭。结论 对心肺功能不能耐受全肺切除的III期上叶中心型肺癌病人 ,自体肺重植是一种可供选择的、能保全肺组织的肺癌根治术式。

Objective To assess the applicability of lung autotransplantation technique in the treatment for central lung cancer of upper lobe. Method Two patients underwent double-sleeve right upper and middle bilobectomy. Because the length of resected bronchus or pulmonary artery was too long to perform a tension-free anastomoses, we had to transect and transplant the lower lobar vein to proximal stump of the upper lobar vein. Another two patients underwent a pneumonectomy in situ, because the tumors extended over the oblique fissure to the margin of the lower lobe, tumor was resected at a separate table, and residual lung was replanted. Result Until feb.2000, the patient 1 and 3 had been alive tumor free for 33 and 20 months. The second patient died of tension pneumothorax following bronchopleural fistula on 19th day postoperatively. In patient 4, resection of the replanted lung was done because of pulmonary artery bronchus pleural fistula on 42nd day,and died of respiratory failure caused by pulmonary infection on 14th month postoperatively. Conclusion Lung autotransplantation is a alternative technique with pulmonary preservation for patient with stage III central lung cancer of upper lobe what his pulmonary reserve is too low to afford pneumonectomy.