应用自体肺叶再植治疗中心型肺癌

Surgical treatment of central lung cancer by lobar replantation

目的 探讨应用自体肺叶再植进行中心型肺癌手术治疗的可行性、适应证和方法。方法 本组共 6例患者。其中 2例采用双袖状右上中肺叶联合切除术 ,因总支气管或肺动脉吻合张力过大 ,切断下肺静脉再植于上肺静脉残端 ,保全了右下肺叶。 4例因肿瘤跨越斜裂侵及下叶边缘 ,先作根治性全肺切除术 ,体外肝素盐水灌注并从离体标本中摘取可保留的下肺叶再植于胸腔内。结果 随访至 2 0 0 0年 1 0月 ,3例患者已分别存活 41、9和 6个月 ,生活质量良好 ;1例术后 1 9个月肺癌复发 ,2 3个月死亡 ;1例术后 1 9天死于支气管胸膜瘘、张力性气胸 ;1例术后 42天因肺动脉支气管胸膜瘘作再植肺叶切除 ,1 4个月后死于呼吸衰竭。结论 对心肺功能不能耐受全肺切除的Ⅲ期上叶中心型肺癌患者 。

Objective To explore the feasibility, indication and method of surgical treatment of central type lung cancer by lobar replantation. Methods A retrospective study on the radical resection of 6 patients with stage Ⅲ central type lung cancer of the upper lobe by lobar replantation was made. Two patients underwent double sleeve right upper and middle lobectomy, firstly. Since the length of resected bronchus or pulmonary artery involved by tumor was too long to perform tension free anastomosis, we had to transplant the inferior pulmonary vein to the proximal stump of the supperior pulmonary vein, so the lower lobe was preserved. Another four patients underwent radical pneumonectomy, because the tumor had extended through the oblique fissure to the margin of the lower lobe. Subsequently, the lower lobe was isolated from the resected lungs and perfused with heparin solution (12?500?U/500?ml normal saline) for later replantation. After a radical systematic en bloc mediastinal lymphadenectomy was performed, the preserved lower lobe was replanted. Results Followed up to Dec 2000, 3 patients had been alive for 43, 12 and 8 months separately with a good living quality. One case had tumor recurrence at 19th month and died at 23rd month postoperatively. One case died of tension pneumothorax caused by bronchopleural fistula on the 19th postoperative day. Another case received resection of the replanted lung for pulmonary arterio broncho pleural fistula on the 42nd day and died of respiratory failure caused by pulmonary infection on 14th month postoperatively. Conclusion Lobar replantation is an alternative procedure of parenchyma sparing in patients with stage Ⅲ central lung cancer of the upper lobe whose cardiopulmonary function is too poor to undergo pneumonectomy.