原发性中叶肺癌的诊断与治疗

Diagnosis and surgical treatment of middle lobe lung cancer

目的:探讨原发性中叶肺癌的临床诊断和治疗特点。方法:总结10年间手术治疗的65例原发性中叶肺癌的诊治经验。本组UICC分期:Ⅰ期10例、Ⅱ期26例、Ⅲ期29例。行根治性肺叶切除手术54例,其中右肺中叶切除术14例,双肺叶切除15例(含袖式肺叶切除术4例),右肺中叶加受侵邻叶部分切除术8例,全肺叶切除17例。行姑息性肺叶切除11例,结果:右肺中叶肺癌发病率低,易误诊和延误诊断,临床上手术治疗的晚期病例较多。动态的比较胸片、胸部CT检查结果,配合纤维支气管镜检查有助于提高早期诊断率。本组病例 1、3年生存率 81.5％、53.8％。Ⅰ、Ⅱ期病人术后3年生存率69.4％、与Ⅲ期病人术后3年生存率34.5％比较差别有非常显著性意义(P<0.005)。根治手术病例3年生存率61.1％,姑息手术病例3年生存率18.2％,两组比较差异有非常显著性意义(P<0.01)。结论:减少原发性中叶肺癌的误诊和延误诊断,是减少晚期病人的重要因素。手术治疗以肺叶切除术为主。在肺功能允许的条件下对跨叶性病变应选择双肺叶、袖式肺叶切除术或全肺叶切除术,避免做受侵肺叶局部切除术,以减少局部复发。

Objective: To study the characteristics of diagnosis and surgical treatment of middle lobecarcinoma of the lung. Methods: sixty five patients with middle lobe carcinoma of the lung had underg-one surgical treatment from 1987 to 1997 in our hospital were analyzed retrospectively. Fifty four radicalresection were taken in which 14 lobectomies, 15 bilobectomies, 8 lobectomies, and partial resection oninvaded adjacent lobe and 17 pneumonectomies. Palliative excision were taken in 11 cases. According toUICC staging system, there were stage Ⅰ 10 cases, stage Ⅱ 26 cases, and stage Ⅲ 29 cases. Postopera-tive chemotherapy was carried out in all the cases. Results: There was no operative death. The overall 1and 3 years survival rate were 81.5% and 53.8% respectively. The 3 years survival rata of stage Ⅰ andstage Ⅱ group was 69.4% and that of stage Ⅲ group was 34.5%. The diferences between the twogroups were statistically significant(P<0.005). The 3 years survival rate in radical resection group was61.1% and higher than that of 18.2% for palliative excision group(P<0.01). Conclusion: It suggeststhat the early diagnosis, early operation and the combination therapy are the key points for improving thelong-term survival rate of the middle lobe lung cancer. It is also recommended to avoid partial resection for the invaded adjacent lobe when patient's condition can stand for multilobectomy, in order to reducelocal recurrence.