体外循环下晚期肺癌左全肺切除+降主动脉置换术探讨

Radical left pneumonectomy and replacement of the part of tumor-invaded descending aorta in advanced lung carcinoma using cardiopulmonary bypass

目的 探索外科治疗晚期肺癌的新途径 ,将体外循环技术用于晚期已浸润到胸主动脉的肺癌手术治疗 ,使常规方法不能切除的肺癌获得根治性切除。方法 取左侧第 5肋床切口进胸 ,经左肺动脉、降主动脉插管建立体外循环。结果 经心包内切除左全肺 ,切除并置换受肿瘤侵犯的降主动脉 ,患者顺利恢复 ,未见与体外循环相关的并发症。结论 体外循环是侵犯心脏大血管肿瘤外科治疗的有效辅助手段之一。侵犯心脏大血管的肿瘤 ,只要没有广泛的远处转移等手术禁忌证 ,就应该努力应用体外循环技术彻底地予以切除。彻底地切除侵犯心脏大血管的肺癌 。

Objective To treat one patient with advanced lu ng carcinoma using combined pneumonectomy and replacement of the part of the des cending aorta invaded by the tumor and probe a new approach to surgical treatmen t of the advanced lung carcinoma. Methods Left posterolateral tho ractomy was employed in the treatment. Cardiopulmonary bypass(CBP) was establish ed by cannulation via the left pulmonary artery and descending aorta. Re sults The surgery was successful. The patient recovered smoothly and no C PB related postoperative complication was observed. Conclusion C PB can be a valuable approach to surgical treatment of tumor invaded thoracic a orta and should be considered first unless there is evidence of metastatic tumor . Complete resection appears to offer a chance for longer survival in patients w ith advanced lung carcinoma that invades the heart and the great vessel.