14例肺动脉肉瘤的外科治疗

Surgical treatment of 14 cases with pulmonary artery sarcoma

目的 比较分析肺动脉肉瘤（pulmonary artery sarcoma,PAS）的外科治疗效果,探讨提高PAS外科治疗效果的方法.方法 2001年11月至2014年1月,北京安贞医院收治19例PAS,其中14例接受外科治疗.现回顾性分析其相关结果.采用SPSS 13.0统计软件进行统计学处理,计量资料以-x±s表示,计量资料比较采用t检验;计数资料比较用Fisher精确概率法检验.P＜0.05为差异有统计学意义.结果 19例患者的肺动脉CTA均显示蚀壁征;14例手术后病理学检查证实为PAS;5例未行手术治疗者PET-CT检查显示氟脱氧葡萄糖摄取异常增高团块影.14例手术中,肺动脉内膜剥脱术12例,一侧全肺切除2例.无围手术期死亡.5例未经手术治疗的患者出院后生存3天至1个月,平均生存（20.0±11.2）天;14例手术患者术后生存5～46个月,平均生存（16.8±3.8）个月,差异有统计学意义（P =0.0001）.进行肺动脉内膜剥脱术的12例中,前4例术中未行深低温停循环,术后平均生存（9.7±2.8）个月;后8例术中进行了深低温停循环,术后平均生存（18.3±3.5）个月,两组差异有统计学意义（P =0.0017）.术后9例未行辅助性放疗化疗患者生存时间为（12.3±3.2）个月,5例行辅助性放疗化疗患者生存时间为（22.8±13.3）个月,差异有统计学意义（P =0.0387）.结论 外科手术治疗可延长PAS的生存期,术中采用深低停循环有助于肺动脉内膜剥脱术中彻底清除瘤体、瘤栓和附加血栓,因而有助于延长生存时限.辅助性化疗和放疗可进一步延长患者的生存期.

Objective Our aim was to investigate the effect and prognosis of surgical treatment to pulmonary artery sarcoma（PAS）.Methods From November,2001 to January,2014,nineteen PAS were diagnosed,and 14 of them were surgically treated at Beijing Anzhen Hospital,and the data were retrospectively reviewed.Results All 19 patients underwent pulmonary artery CTA scan,and all showed a filling defect within the lumen of the pulmonary artery with a sign of wall eclipsing on pulmonary artery CTA; 14 patients were confirmed pulmonary artery sarcoma through histo-pathological investigation after surgery; the other five patients were confirmed to have FDG abnormal high intake mass shadow in PET-CT scan.Fourteen patients underwent surgical treatment,including 12 cases of pulmonary endarterectomy,two cases of pneumonectomy,and the other five patients had no indication for operation and died very soon.There were no perioperative deaths for surgically treated patients.Five patients without surgical treatment survived 3 days to one month after discharge.14 patients survived 5-46 months after surgical treatment,with an average survival of（16.8 ± 3.8） months,the difference between the two groups reached statistically significance（t test,P =0.0001）.Of the 12 patients with pulmonary endarterectomy,the first four cases did not and the later eight cases did undergo deep hypothermic circulatory arrest during the procedure,and their average survival were（9.7 ± 2.8） and （18.3 ± 3.5） months respectively,and the difference between them reached a statistical significance.Of the 14 patients with surgical resection,9 patients did not and the other 5 did received adjuvant radiotherapy and chemotherapy,their average survival were（12.3 ±3.2） and（22.8 ±13.3） months respectively,and the difference between the two groups reached statistically significance（t test,P =0.0387）.Conclusion Radical surgical resection can provide the longer survival than non-surgical treatment to the PAS patients.Intraoperative deep hypothermic circulatory arrest helps to fully eliminate the tunor body,tumor thrombus and superimposed blood clots,thus helps to prolong the survival time.And adjuvant chemotherapy may further extend their survival.