支气管袖状肺叶切除术49例临床分析

CLINICAL ANALYSIS OF 49 CASES OF LOBECTOMY WITH SLEEVE RESECTION

对 49例患者施行支气管袖状肺叶切除术 ,其中恶性肿瘤 46例 ,良性病变 3例。恶性肿瘤分期Ⅰ期2 9例 ,Ⅱ期 15例 ,Ⅲa期 2例。支气管袖状上叶肺切除术 43例 ,支气管楔形右上叶切除术 2例 ,支气管成形肺动脉成形左上肺叶切除术 2例 ,支气管成形左下肺叶切除术 2例。全组无手术死亡 ,术后无支气管吻合口瘘及狭窄等严重并发症发生 ;恶性肿瘤术后随访 1、5、10年生存率分别为 93.0 %、48.1%和 8.3%。结果提示 ,对肺癌患者选择术式应视病人个体情况而定 ,为了尽可能多地保存健康肺组织 ,对心肺功能差者应选择袖状肺叶切除 ,避免全肺切除 。

Of the 49 patients(male 43, female 6) collected from October 1983 to April 2000, 46 were malignancy with 29 in TNM stage I, 15 in stage II, and 2 in stage Ⅲa. Age ranged from 10～68. Upper lobectomy with sleeve resection was performed in 43 cases(14 in left lung, 29 in right lung) and right upper lobectomy with wedge bronchoplasty in 2 cases, left upper lobectomy with bronchoplasty and angioplasty in 2 cases , left lower lobectomy with sleeve resection in 2 cases. There was no mortality in our group and all patients recovered well. No such major complications as bronchial anastomotic fistula or stenosis occurred. The 1,5 and 10 year survival rates of malignant cases were 93.0%, 48.1% and 8.3% respectively. The results suggested that the operation plan for malignant lung diseases should be made individually. However, instead of a total pneumonectomy, a sleeve lobectomy is sometimes preferabe for the sake of the safety in those with poor cardiopulmonary function to save the lung capacity as much as possible.