肺转移瘤的外科治疗

目的探讨肺转移瘤外科治疗的指征、术前评价、手术方法及影响预后的因素。方法对106例肺转移瘤的临床资料进行回顾性分析。结果经手术治疗的肺转移瘤106例，其中转移性癌86例，转移性肉瘤20例，二者5年生存率分别为19.8%和20%。以原发肿瘤乳腺癌、头颈部癌、泌尿系癌及骨肉瘤的肺转移预后较好，5年生存率分别为33.3%、27.3%、20%及33.3%。全组1年、3年、5年和10年生存率分别为83%、35.8%、9.8%和6.6%。术后行辅助放/化疗者的5年生存率为18.1%，未行者23.5%，二者间差异不显著。全组并发症的发生率为4.2%，无手术死亡。结论对原发肿瘤已达根治，无他处转移及肺功能可承受手术者作为手术指征；手术途径以病侧后外切口为主；探查时应避免遗漏多发转移灶，遵循最大限度切除肺转移瘤及保留正常肺组织的原则；重视前瞻性的术后辅助治疗，以期提高手术疗效。

Surgical managementfor pulmonary metastases(106 cases report)

AimTo review theexperience of surgical treatmen tof pulmonary metastased.Clinical material and methodFrom1961 to 1997,118 resections for pulmonary metastases were performed in 106 patients,86with carcinoma and 20 with sarcoma. The surgical procedures included 73 wedgeresections,44 lobectomies and 1 pneumonectomy.ResultThe surgical morbidity was 4.2%,andthere was no operative mortality.The overall 5-year survival rate was 19.8% for patientswith carcinoma,and 20% for those with sarcoma.For various sites of primary malignanciestheir 5-year survival was quite different.The better outcomes ranged in the groups ofmetastases from breast cancer,head and neck carcinoma,urinary tract cancer andosteosarcoma,which were 33.3%,27.3%,20%,and 33.3%,respectively.The 5-year survival formetastases from melanoma,oesophageal and gastric cardiac carcinoma was very poor.ConclusionWe emphasize the importance of a thorough evaluation for metastases,an strictindication in selecting patients,and a careful exploration.The combination of severalsignificant individual factors was the best indicator for evaluating the postoperativelong-time survival.A planned postoperative adjuvant chemotherapy and/or radiotherapy wouldplay a more important role in the treatment of pulmonary metastases.