肺癌侵犯膈肌6例外科治疗体会

Surgical Management of Non-Small Cell Lung Cancer Invading the Diaphragm

对6例侵犯膈肌的非小细胞肺癌进行回顾性分析,其中肺叶切除4例,双肺叶切除1例,左全肺切除1例,6例均伴受侵膈肌切除+膈肌修复术,术后辅助化疗。结果表明,6例切除标本病理证实均为肺鳞状细胞癌侵犯膈肌,术前均未疑诊。2例N_0病人术后14、31个月健在,1例N_1病人术后25个月死亡。3例N_2病人分别于术后9、10、18个月死亡。因此,正确评价纵隔状态以采取不同的治疗组合是改善预后的关键。

In order to increase the understanding of surgical management of non-small cell lung cancer invading the diaphragm, 6 cases with this kind of disease were analysed retrospectively. Surgical managements were performed including lobectomy in four, bilobectomy in one, and left meumonectomy in one. The diaphragm was resected en bloc with the tumor and underwent primary closure in six patients, and all had postoperative adjuvant chemotherapy. The results showed that in all resected specimens, the tumor had squamous cell carcinoma and im-vaded the diaphragmatic muscle pathologically, and diaphragmatic invasion was not suspected before the operation. Two patients with N0 disease are still alive at present, one is 14 months after the operation and the other is 31 months. Four in the six cases dide, survival after the operation was 25 months in one patient with N1 disea-se and 9, 10, 18 months in three patients with N2 disease respectively. It is concluded that the key in improving prognosis is correct evaluation of the mediastinum and selection of the combination of the therapeutic modalities.