侵犯脊柱的肺上沟瘤(Pancoast瘤)的外科治疗

Surgical treatment of superior pulmonary sulcus(Pancoast)tumor invading spine

肺上沟瘤(Pancoast瘤)由于手术暴露困难,局部解剖复杂,历来属于胸外科手术技术中的难点。侵犯脊柱的Pancoast瘤,曾一度被认为不可切除,列为手术禁忌证。目前,随着胸外科技术的不断进步,以及多学科诊疗模式的初步建立,已有多个中心可在神经、脊柱外科的辅助下完成椎体切除与重建的同期手术,对伴有脊柱侵犯的Pancoast瘤实现整块的R0切除,并取得良好预后。术前诱导治疗的应用极大提高了肿瘤的可切除率。而腔镜辅助的杂交手术减少了手术创伤,对术后并发症率的控制具有潜在价值。

Superior pulmonary sulcus tumor,also known as Pancoast tumor,has long been a challenge in thoracic surgery,due to its difficulty in exposure and complexity in local anatomy.Pancoast tumor with spine invasion was once thought to be inoperable and was listed as a contraindication to surgery.More recently,with the development in surgical techniques and the establishment of multidisciplinary approaches,several specialized centers have claimed the achievement of en bloc R0 resection of Pancoast tumor with spine invasion,which was accomplished by vertebral resection and reconstruction in cooperation with neurosurgeons.Some patients survived a long time after surgery.On the other hand,the use of induction therapy extends resectability preoperatively,and hybrid surgery with the assistance of a thoracoscope would lead to less surgical trauma,showing a promising potential in morbidity control.