跨级支气管吻合呼吸道重建术在中央型肺癌手术中的应用

Cross Level Bronchial Anastomosis and Respiratory Tract Reconstruction in Surgery of Central Bronchogenic Carcinoma

目的总结广泛型袖式肺叶切除,跨级(段支气管和主支气管吻合)支气管吻合呼吸道重建术的手术技巧和经验。方法回顾性分析20例接受跨级支气管吻合呼吸道重建术患者的临床资料。结果全组20例患者手术均顺利完成,无术中大出血及手术死亡,无支气管胸膜瘘、吻合口狭窄、呼吸衰竭及肺动脉血栓形成。术后并发肺不张、肺部感染3例,心房纤颤2例,声音嘶哑1例。随访18例,时间1月～6年,1、3、5年生存率分别为83.3%、28.6%和14.3%。结论跨级支气管吻合呼吸道重建术能达到与全肺切除相似的切除肿瘤的彻底性,同时最大限度地保存肺功能,扩大了手术适应证,提高了病人的生存质量,是一种有效可行的术式。

Objective To summarize the skills and experience on cross level bronchial anastomosis and respiratory tract reconstruction in surgical treatment of central bronchogenie carcinoma. Method The data of 20 central bronchogenic carcinoma patients underwent extended sleeve lobectomy and cross level bronchial anastomosis were reviewed. Results All operations were accomplished without operative death. There was atelectasis and pulmonary infection in 3 cases, auricular fibrillation in 2 cases and hoarseness in 1 case. No other serious complication such as bronehopleural fistula, respiratory failure, pulmonary artery thrombosis and anastomotic stoma stenosis occurred. 18 cases were followed up for 1 month to 6 years. The 1-,3- and 5 year survival rates were 83.3%, 28.6% and 14.3%. Conclusions Cross level bronchial anastomosis and respiratory tract reconstruction is an effective and feasible surgical technique for central bronehogenie carcinoma. It can achieve a similar effect of pneumonectomy, preserve remnant pulmonary function at the largest extent, so it enlarges the adaptation of operation, and improves the living quality of the patients.