肺切除并肺减容术治疗肺癌及重度肺气肿

Lobectomy combined with lung volume reduction for patients with lung cancer and severe emphysema

目的 总结 3例早、中期非小细胞肺癌合并重度肺气肿病人施行一侧肺切除并对侧肺减容术的治疗经验。方法 3例男病人 ,年龄 6 0～ 6 4岁。鳞癌 2例 ,腺癌 1例。 2例癌肿位于右上肺叶 ,1例在左下肺叶。分期Ib 期 2例 ,IIa期 1例。术前气急分级 :2级 1例 ,3级 2例 ,第一秒用力呼气量(FEV1)平均 0 90L(36 3%预计值 )。动脉血氧分压 (PaO2 )平均 73 5mmHg(1mmHg =0 133kPa)。 6min行走平均 2 87 7m。肺癌行肺叶切除 2例、肺楔形切除 1例 ;同期切除对侧肺组织 (靶区 ) 2 0 %～ 30 %。结果 3例病人术后恢复顺利。术后近期病人自觉症状如胸闷、气急等改善 ,气急指数均比原先上升 1级。随访 1～ 6个月FEV1较术前上升 0 40L ,PaO2 增加 2 0 5mmHg,6min行走增加增加 46 7% (平均 42 1m)。结论 对有选择的早中期肺癌合并重度肺气肿病例 ,同期施行肿瘤一侧肺切除及对侧肺减容术是适宜的治疗方法 ,从而扩大了肺癌的手术适应证。

Objective: To evaluate the effects of lobectomy combined with lung volume reduction for patient with early stage NSCLC and severe emphysema. Methods: All 3 patients were male. Age ranged from 60 to 64 years. Histological type of the lung cancer was squamous carcinoma in 2 and adenocarcinoma in 1. The tumor located in right upper lobe in 2 and left lower lobe in 1. Preoperative dyspnea index was grade 2 in 1 and grade 3 in 2. Mean FEV 1 was 0.90 l(36.3%), mean PaO 2 was 73.5 mm?Hg and the mean 6 minute walk was 287.7 m. Operative procedures included lobectomy in 2 and wedge resection in 1. Lung volume reduction surgery was performed in all patients (20%～30%) contralateral lung tissue were resected. Results: There was no major complication. All patients recovered well. After operation, the symptoms such as palpitation, dyspnea was improved significantly. 3 patients were followed up 1 to 6 months, FEV 1, PaO 2, 6 minute walk and dyspnea index were increased by 40%, 20.5 mm?Hg, 46.7% and 1 grade, respectively. Conclusion: For selective early stage NSCLC patients with severe emphysema, lobectomy combined with LVRS is an effective method. It can provide significant functional benefit and symptomatic relief. It widens the operative indication for lung cancer.