直肠癌术后转移性肺癌的外科疗效

Analysis of surgical effectiveness of rectal cancer lung metastases

目的 研究直肠癌肺转移的病人的外科疗效。方法 我院胸外科 1 978年 1月到 2 0 0 0年 1 0月为 32例直肠癌肺转移患者施行了肺切除术。直肠癌术后无瘤间期为 0～ 1 0 8月 (平均为 44 .6月 )。孤立病灶者 2 6例 ,占 81 .3 % ,累及两个肺叶者 4例 ,占 1 2 .5 %。结果 楔形切除 1 2例 ,一叶切除 1 4例 ,两叶切除 2例 ,全肺切除 3例 ,姑息性切除 1例。全组无手术期死亡 ,平均随访 8年 ,随访为 1 0 0 %。 1年、3年、5年、1 0年的生存率分别为 78.6 %、46 .3 %、2 8.7%、1 8.1 %。资料显示多发性转移病人的生存期明显小于孤立性病灶者 (P <0 .0 5) ,肺手术前癌胚抗原正常组生存期明显大于增高组病人 (P <0 .0 1 )。结论 对于直肠癌肺转移的病人在尽可能多保留肺组织的情况下实行肺切除术是安全。

Objective To study surgical effectiveness of rectal cancer lung metastases. Method Between Jan. 1978 and Oct. 2000 thirty-two consecutive patients underwent pulmonary resection for metastatic rectal carcinoma in this hospital. Median interval between rectectomy and lung resection was 44.6 months. Twenty-six patients (81.3%) had a solitary metastasis. Two lobes were invaded in four patients (12.5%). Results Wedge excision was performed in 12 patients, lobectomy in 14, bilobectomy in 2, pneumonectomy in 3 and palliative resection in only one. There was no operative mortality. Follow-up showed that 1-,3-, 5- and 10-year survival rates were 78.6%, 46.3%, 28.7%, and 18.1% respectively. Clinical analysis showed at survival rate of multiple metastatic neoplasm was lower than that of single ones ( P <0.05). Before lung resection, patients with normal serum level of carcinoembryonic antigen had a longer survival than that with increased level ( P <0.01). Conclusion By means of reserving enough lung tissue to maintain adequate lung function, pulmonectomy is safe and effective for treating rectal cancer lung metastasis.