肺部转移性肿瘤患者的手术方式选择及预后因素分析

Analysis of the Choice of Operation Mode and Prognosis Factors of Patients with Tumors of the Lung Metastasis

背景与目的肺部转移性肿瘤的治疗观念有所改变,外科手术的治疗价值及影响预后的因素值得探讨。方法回顾性分析2006年1月-2009年12月经手术治疗的57例肺部转移性肿瘤患者的临床资料,随访1年、3年、5年生存率,比较胸腔镜和常规开胸两种手术方式的差别,探讨患者性别、年龄、手术方式、无瘤生存间隔期(disease-free interval,DFI)、转移瘤数目、转移瘤大小及术后是否化疗与预后的关系。结果全组患者围手术期无死亡,患者术后1年、3年、5年生存率分别为81.3%、46.5%、29.2%,中位生存时间为33.8个月。多因素分析显示DFI、转移瘤数目和直径是影响预后的独立因素。结论合理选择手术治疗,能够提高肺部转移性肿瘤患者的生存期,胸腔镜是优选的手术方式,孤立性肺转移瘤及直径<4 cm的患者手术效果更佳。

Background and objective Concept of treatment for pulmonary metastatic tumor has been changed. The aim of this study is to analysis of the choice of operation mode and prognosis factors of patients with tumors of the lung metastasis. Methods The dinical data of 57 patients with pulmonary metastases who underwent operations from January 2006 to December 2009 were retrospectively analyzed. Difference of conventional open thoracic surgery and thoracoscope surgery was compared. The relationship between gender, age, type of surgery, disease-free interval （DFI）, the number of metastatic tumor, the size of tumor, chemotherapy and prognosis was explored. Results Among the patients, there was no perioperative mortality. Postoperative 1-, 3-, 5-year survival rates were 81.3%, 46.5% and 29.2%, the median survival time was 33.8 months. Multivariate analysis showed that DFI, the number and diameter of metastasis tumor were independent prognostic factors. Conclusions Reasonable choice of surgical treatment can improve the survival of pulmonary metastatic tumor patient. Thoracoscopic surgery method is preferred. Operation effect of patients with tumor diameter less than 4 cm in solitary pulmonary metastasis has better effect.