晚期肺癌的心包内全肺切除加低渗温热化疗

Pneumonectomy within pericardium combined with hypotonic moderate-hot chemotherapy for lung cancer of Ⅲ-Ⅳ stages

目的探讨已有“肺门冻结”状态的晚期肺癌切除方法,并在术中辅以低渗温热化疗。方法进胸后不作过多探查分离,首先选择合适部位切开心包,于肺动、静脉起始部放置7-0～10-0线单纯结扎,阻断血流,尔后再转入外围操作。胸腔内采用低渗蒸馏水温热化疗药物进行浸泡冲洗。结果46例(Ⅲa期29、Ⅲb期12、Ⅳ期5)中29例心包内预置阻断线,17例心包外预置阻断线,全组46例切除率为100%,术中平均输血<100ml,未出现意外险情。结论对晚期肺癌采用分离前预置动、静脉阻断线(不切断),可有效提高晚期中心型肺癌的切除率,减少出血,增加了手术的安全性。采用胸腔内低渗温热化疗,减少了胸水的发生率,提高了手术治疗效果。

Objective To discuss the feasibility of resection procedure for advanced lung cancer with'hilar freeze'state assisted by a hypotonic moderate-hot chemotherapy during operation.Methods More explorative disassociation did not made after approaching into thorax,but selecting suitable region at first and cuting pericardium.Setting gauge7-0,10-0thread at the start site of pulmonary artery and pulmonary vein,which were simply ligated and blocked blood flow,then progression performance was made at outer part.Hypotonic moderate-hot distillated water chemotheraphy drugs immersion and flushing in thorax were used.Results Among the46patients including stagesⅢa(29cases),Ⅲb(12cases)andⅣ(5cases),29were set block thread in pericardium and17out pericardium,the resection rate was100per cent.However,the average volume of blood transfusion was less than100ml,and there was no accident danger during operation.Conclusion Using precondition block of arteries and veins before disassociating(not amputation)for late lung cancer,which would effectly increase resection rate of late centricity lung cancer,may decrease bleeding and raise safety of operation.Using hypotonic moderate-hot chemotherapy in thorax would decrease the prevalence of pleural effusion and increase the efficacy of operation treatment.