肺动脉、支气管成形肺叶切除术与肺叶、全肺切除术的比较

目的:通过与常规肺叶、全肺切除术的比较,探讨肺动脉、支气管成形肺切除术的手术适应证.方法:我科1980～2000年间行肺动脉、支气管成形肺叶切除手术的原发性非小细胞肺癌患者64例,其中TNM分期N0期21例, N1期28例, N2期15例.总结此类手术的操作和围手术期处理经验,并按TNM分期比较术后第3、5、10年的生存率.另选取同期常规全肺切除术和常规肺叶切除术患者各64例,比较三种术式术后病死率和并发症率.结果:肺动脉、支气管成形肺切除术组的第3、5、10年生存率分别为58%、42%、19%,中位生存时间为45.76个月,其中21例N0患者的第3、5、10年生存率分别为82%、56%、29%,28例N1患者的第3、5、10年生存率分别为56%、39%、27%,15例N2患者的第3、5、10年生存率分别为21%、12%、0,不同分期间均存在显著差异(P<0.01).肺动脉、支气管成形肺切除术术后病死率及并发症率与同期手术的常规全肺切除术相比无显著差异,但高于肺叶切除术(P<0.01).结论:肺动脉、支气管成形肺切除术扩大了肺癌的手术适应证,提高了术后的生存质量,此类手术主要适合于上叶中央型N0、N1非小细胞肺癌患者,对于N2患者应慎重.

Broncho-angioplastic pulmonary resection, pneumonectomy and lobectomy: a comparison study

Objective:To search for the indications of broncho-angioplastic pulmonary resection by comparing it with pnumonectomy and lobectomy in patients with non-small cell lung cancer.Methods: Sixty-four patients with non-small cell lung cancer(TNM classification: T0 21,N1 28 and N2 15) underwent broncho-angioplastic pulmonary resection in our hospital from 1980 to 2000.The experience on the operative method and perioperative managements were summarized and the postoperative mortalities were compared between patients with different TNM classifications.Meanwhile,64 non-small cell lung cancer patients receiving pneumonectomy and 64 receiving lobectomy during the same period were also included in this study,and their postoperative mortalities and complications were compared with those of broncho-angioplastic pulmonary resection.Results: The 3,5 and 10-year survival rates of patients receiving broncho-angioplastic pulmonary resection were 58%,42% and 19%,respectively,with a medium survival time of 45.76 months.The 3,5 and 10year survival rates of 21 N0 patients were 82%,56% and 29%,respectively;of 28 N1 patients were 56%,39% and 27%,respectively;and of 18 N2 patients were 21%,12% and 0,respectively.Significant difference was found between each TNM classification group in survival rates(P<0.01).The postoperative mortalities and complications in patients receiving broncho-angioplastic pulmonary resection were similitar with those of pneumonectomy,but significantly higher than those of lobectomy(P<0.01).Conclusion: Broncho-angioplastic pulmonary resection expands the indication spectrum of the lung cancer and improves the post-operation life quality of patients.Broncho-angioplastic pulmonary resection is suitable for patients with lung cancer of N0 or N1 status,but not recommandable for N2 status.