瘤体直径超过10厘米肺癌的手术切除方法探讨

Surgical approach for lung cancer larger than 10 cm

目的探讨瘤体直径超过10cm肺癌的手术切除方法。方法分析自2009年3月至2011年10月，首都医科大学附属北京世纪坛医院胸外科13例该型肺癌的临床资料。全部病例经改良前外侧剖胸人路进胸腔暴露前肺门，立即切开心包控制肺血管。然后仔细解剖叶间裂，在排除肺叶切除可能性之后，果断行全肺／扩大全肺切除。结果13例该型肺癌经改良前外侧剖胸入路完成了心包内全肺扩大全肺切除术顺利，术后恢复平稳。结论瘤体直径超过10cm肺癌手术成功的关键是开胸后迅速在心包内控制肺血管；改良的前外侧入路有利于完成此操作；多为全肺切除。

Objective To discuss the surgical techniques for lung cancer larger than 10 em. Methods Via a modified anterolateral thoracotomy entered through the 4th or 5th intercostal space, intrapericardial access to pulmonary vessels was obtained for pneumonectomy or extended pneumoneetomy in all patients, after excluding the feasibility of lobeetomy. Results From March 2009 to October 2011, 13 consecutive patients with lung cancer larger than 10 cm,were admitted to surgical resection via this approach for intrapericardial pneumonectomy/extending pneumonectomy. The whole processes were smooth and without any major morbidity. Conclusions The main approach for lung cancer larger than 10 em is pneumonectomy. The key to surgical success is intrapericardial controlling of the hilum vascular. The modified anterolateral thoraeotomy may facilitate this procedure.