肺癌累及上腔静脉的外科治疗

目的分析探讨肺癌累及上腔静脉行手术切除的可行性及价值。方法回顾性分析1988年3月—2005年4月的31例肺癌累及上腔静脉手术治疗患者的临床资料,其中鳞癌17例、腺癌8例、小细胞未分化癌6例;N0．1期12例,N2期19例;T4期22例,T2．3期9例。采用上腔静脉切除人工血管置换（18例）,侧壁切除自体心包片修补（8例）、直接缝合（5例）的方法处理切除后的上腔静脉,统计围手术期并发症及长期生存率,分析生存及预后情况。结果18例上腔静脉置换者中,上腔静脉阻断者17例,阻断时间8～35min;13例上腔静脉部分切除修补者,9例阻断上腔静脉,阻断时间3～15min。无手术死亡,术后并发症发生率为48％（15／31）。术后随访28例,时间3～130个月,总的中位生存期为31个月,1,3和5年生存率分别为61％,33％和21％,其中N1．1期、N2期患者的中位生存期分别为42和13个月（x^2=14．3,P=0．000）;病理类型及手术方式对预后无影响;术前及术中化学治疗（化疗）的患者预后好于术前及术中未化疗者,中位生存期分别为39和14个月（x^2=5．0,P=0．025）。结论肺癌累及上腔静脉进行手术治疗可行,无纵隔淋巴结转移者预后较好,应尽可能手术治疗;术前或术中化疗值得推荐。

Resection for lung cancer invading the superior vena cava

OBJECTIVE: To analyze the feasibility and the value of resection for lung cancer invading the superior vena cava (SVC). METHODS: Between 1988 and 2005 the data of 31 patients who underwent resection were analyzed retrospectively. The reconstruction was done using simple suture, pericardial patch or prosthetic replacement. Postoperative morbidity, long-term survival were examined using the Kaplan-Meier method (Log rank test) and the COX model for survival. RESULTS: Seventeen squamous cell carcinomas, 8 adenocarcinomas, and 6 undifferentiated small cell carcinomas were resected. There were 13 partial SVC resection, the reconstruction was done using a simple running in 5 patients, and a pericardial patch in 8 patients. Eighteen patients underwent complete resection of SVC with prosthetic replacement. The time of clamping the SVC system was from 8 to 35 minutes for complete resection patients, while the time was from 3 to 15 minutes for partial resection patients. One patient didn't clamp the SVC. Postoperative morbidity and mortality were 48% and 0%, respectively. One, 3 and 5-year survival rates were 61%, 33% and 21%, respectively, with median survival at 31 months. Survival rate of patients with N2 disease was obviously lower than those with localized (N0/N1) nodal disease (chi2 = 14.3, P = 0.000), the median survival was 42 and 13 months respectively. There were no significant effects on overall survival with pathologic features and surgery methods. Survival rate of patients with induction chemotherapy before operation or intraoperative chemotherapy was higher than those received direct surgery (chi2 = 5.0, P = 0.025), the median survival was 39 and 14 months respectively. CONCLUSIONS: The resection of the SVC for involvement by lung cancer can be performed in selected patients, especially for those with localized (N0/N1) nodal disease. Induction chemotherapy should be performed.