多段支气管成形呼吸道重建术在肺癌治疗中的应用

Multi Segmental Bronchoplasty and Reconstruction of Airway in Surgical Operation on Lung Cancer

目的:总结段支气管袖式肺叶切除,多段支气管成形呼吸道重建术在肺癌外科手术中应用的经验。方法:对16例中心型肺癌患者自段支气管开口处或以下行肺叶袖式切除,再将离散的各段支气管组联成形与近端支气管吻合,重建呼吸道,保留部分健康肺组织。同时行肺动脉袖式切除3例,上腔静脉袖式切除2例。术后单纯化疗3例,单纯放疗5例,放、化疗4例。结果:所有手术均顺利完成,无手术死亡。3例术后2～5d出现肺膨胀不全,治疗后均痊愈。术后1、3、5、7年生存率分别为87.5％(14/16)、46.1％(7/13)、44.4％(4/9)、16.7％(1/6)。结论:多段支气管成形呼吸道重建术能达到与全肺切除相似的切除肿瘤的彻底性,同时较大限度地保存肺功能,扩大了手术适应证,提高了病人的生存质量,是一种有效可行的术式。

Objective: To summarize the experience of multi segmental bronchoplasty and reconstruction of bronchi in surgi-cal treatment of lung cancer. Methods: 16 patients of centre lung cancer accepted sleeve resection at or below proximal segmental bronchus, then took shaping the dispersed segmental bronchus, anastomosed them with the proximal bronchus to recon-struct the airway. Preserved part of sound pulmonary tissue. And in the operations, 3 patients accepted pulmonary artery sleeve resection. 2 patients accepted superior vena cava sleeve resection . 3 patients accepted postoperative chemotheraphy, 5 patients accepted postoperative radiotherapy, 4 patients accepted chemo - radiotherapy after operation. Results: All operations were accomplished without operative death. 3 patients got atelectasis in 2-5 days after operation, and recover soon after thera-py. Theoverall 1、3、5 and 7 year survival rates were 87.5% ,46.1% ,44.4%, 16. 7% .Conclusion: Multi segmental bron-choplasty and reconstruction of bronchi can reach a similar effect compared with pnenumonectormy and in the same time it can preserve remnant pulmonary function at the largest extent, so it enlarges the adaptation of operation, improves the living quali-ty of the patients. It is an effective.practicable surgical technique.