局部晚期肺癌外科手术治疗(附18例报告)

目的为提高晚期肺癌患者的外科手术切除率及提高手术疗效，总结18例晚期肺癌患者手术治疗中切开心包处理肺静脉或切除部分左心房的经验。方法对18例晚期肺癌患者施行肺叶或全肺切除时，在心包内处理肺静脉或切除部分左心房。左肺下叶切除5例、左全肺切除3例、右肺中下叶切除4例、右肺下叶切除4例、右全肺切除2例；术中发现13例患者的肺静脉根部有癌侵犯或有癌栓，在心包外元法常规处理肺静脉，在切开心包后可较满意地处理肺静脉，切开心包后发现其中有9例明显有左心房侵犯，行肺切除的同时切除部分左房；5例虽可在心包外处理，但癌肿离肺静脉根部太近处理肺静脉困难，而切开心包后处理肺静脉很轻松。结果18例均无手术死亡，术后有2例发生心律失常，2例并发肺炎，1年生存率61．2％（11／18）、3年生存率38．8％（7／18）、2例生存〉5年。结论晚期肺癌累及肺静脉根部或左心房时应切开心包处理肺静脉或同时切除部分左心房以达到肿瘤学上的根治性切除，从而延长病人的寿命。

Significance of dealing with bases of pulmonary veins within pericarvlium or resection of part of left atrium in surgical treatment for advanced lung cancer

Objective To improve the therapeutic effect of surgical method for locally advanced lung cancer, the clinical experience about handling the pulmonary veins after opening the pericardium or resection of part of the left atrium in treatment of 18 patients with this kind of diseases was summarized. Methods Lobectomy or pneumonectomy combined with handling pulmonary veins after opening the pericardium or resection of part of the left atrium were carried out in 18 patients with locally advanced lung cancer. The operations included left lower lobectomy in 5 cases, left pneumonectomy in 3 cases, right middle and lower lobectomy in 4 cases, right lower lobectomy in 4 cases and right pneumonectomy in 2 cases respectively. The bases of the pulmonary veins were invaded by the tumor in 13 patients and can all be dealt with satisfactorily after opening the pericardium, while 9 of them were operated using lobectomy or pneumonectomy combined with resection of part of the left atrium because of the left atrium being invaded obviously. Results There were no operative mortality in this series, 4 patients had operative complications, including arrhythmia in 2 cases and pneumonia in 2 cases. The 1, 3-year survival rates were 61.2%, 38. 3% respectively. 2 patients had survived 5 years. Conclusion Handling the pulmonary veins after opening the pericardium or resection of part of the left atrium for advanced lung cancer invading the base of the pulmonary veins and the left atrium can remarkably increase the long-term survival and improve the prognosis in patients with locally advanced lung cancer if the invasion is limited and the resection is complete.