气管隆凸、支气管成形肺切除术治疗中心型肺癌94例

Tracheal carina reconstruction and bronchoplasty in the treatment of 94 central type bronchogenic carcinomas

目的 分析气管隆凸、支气管成形肺切除术治疗中心型肺癌的近期和远期疗效。方法 自 1985年 4月到 1999年 5月共手术治疗原发性肺癌 90 2例 ,其中气管隆凸、支气管成形肺切除术 94例 ,即支气管成形术 80例 ,隆凸切除 14例。结果 术后发生肺不张 9例 ,心律失常 2例 ,吻合口瘘 1例 ,手术死亡率为 0。 1年生存率为 83 .1% ( 74/89) ,3年生存率 5 8.3 % ( 3 5 /5 6) ,5年生存率 3 4 .0 % ( 18/5 3 )。ⅠB期 5年生存率 66.7% ( 6/9) ,ⅡB期 40 % ( 6/15 ) ,ⅢA期 2 1.1% ( 4 /19)。讨论了病例选择 ,淋巴结廓清 ,支气管和肺血管处理 ,以及上腔静脉替换和修补。结论 支气管成形术治疗肺癌的疗效取决于疾病的分期和正确的适应症选择 ,术中的根治切除和术后的综合治疗。

Objective To analyze the short term effects and long term survival of patients with lung cancer underwent tracheal carina reconstruction and bronchoplasty. Methods From April 1985 to May 1999, 94 patients with lung cancer underwent tracheal carina reconstruction and bronchoplasty, 14 for carinal resection and reconstruction and 80 for bronchial sleeves. Results Postoperative complications were atelectasis (19 cases), arrthymia (2 cases) and anastomotic leakage (1 case). There was no operative death in this series. The 1 , 3 and 5 year survival rates were 83.1%(74/89), 58.3%(35/56) and 34.0%(18/53) respectively for the entire group. The 5 year survival rate was 66.7%(6/9) in stage ⅠB disease, 40%(6/15) in ⅡB disease and 21.1%(4/19) in ⅢA disease. The indication of these procedures and the methods of lymph node dissection, bronchoplasty and pulmonary artery reconstruction, and superior vena cava reconstruction have been discussed. Conclusion Bronchoplasty for lung cancer is a safe and effective therapy. The long term survival depends on the stage of lung cancer, proper selection of surgical indication, clearance of lymph nodes in operation and multiple modality therpay after operation.