双原发肺癌的诊断及外科治疗

Diagnosis and surgical treatment of double primary lung cancer

目的 探讨双原发肺癌的合理诊断及有效的外科治疗方法。方法 对 34例双原发肺癌患者的临床资料进行回顾性分析。结果 全组双原发肺癌共 34例 ,占同期收治肺癌患者的 1 2 %。异时性 2 2例 ,同时性 12例。异时第二原发肺癌行肺叶切除 10例 ,局部切除 11例 ,探查 1例 ,手术并发症发生率、手术死亡率及 5年生存率分别为 13.6 %、4.6 %和 2 5 .0 %。同时双原发肺癌行肺叶及全肺切除各 2例 ,其余均至少有 1个肿瘤行局部切除 ,无手术并发症及手术死亡 ,5年生存率 14.3%。结论 双原发肺癌的诊断率较低 ,应加强术前检查、术后随诊及鉴别诊断。术式选择过于保守及淋巴结清扫不彻底 ,是患者预后不佳的主要原因 。

Objective To arrive at a rational diagnosis and effective surgical treatment of double primary lung cancer.Methods Thirty four patients with double primary lung cancers were operated in our department from 1977 to 1999. Results Twenty two lesions were metachronous and 12 synchronous. Among the patients with metachronous second primary lung cancer, 10 were treated by lobectomy, 11 by partial resection and one was explored only. The morbidity, mortality and 5 year survival rates were 13.6%, 4.6% and 25.0%, respectively. Among the synchronous double primary lung cancer patients, 2 were treated by lobectomy and 2 by pneumonectomy and the others by partial resection at least for one tumor. There was no morbidity or mortality, and the 5 year survival rate was 14.3%.Conclusion Because of the low detection rate of double primary lung cancer, preoperative diagnosis, differential diagnosis and postoperative follow up must be paid with due attention. Conservative operation and incomplete lymph node disection, being the chief reasons of poor outcome, should be stressed. [