肺内同时性多原发癌的临床诊断与治疗

目的总结5例肺内同时性多原发肺癌诊断和治疗经验。方法对经病理证实的肺内同时性多原发肺癌5例进行临床回顾性分析。结果肺内同时f生多原发肺癌的发生率占上海交通大学医学院附属新华医院呼吸科住院同期肺癌的0．21％；其中男4例，女1例；发病年龄为44—75岁，平均年龄为60．2岁。5例患者均行手术治疗。对4例双侧同时性多原发肺癌患者分期进行手术治疗，病灶较大的一侧行常规开胸肺叶切除术，病灶较小的一侧1个月后行胸腔镜肺叶或病灶楔形切除术。对1例肺内同侧同时性多原发癌患者行同期手术。5例患者均无围术期死亡，无严重心肺并发症。5例患者均随访3年，1年和3年生存率分别为80．0％（4／5）和60．0％（3／5）。结论随着医学的发展，医患对肺多原发癌认识的不断增强，其早期诊断和检出率不断提高，采取积极的手术治疗，可使肺内同时性多原发癌患者获得较为理想的预后。

Diagnosis and Treatment of Synchronous Multiple Primary Malignant Tumors in Lung

Objective To summarize the diagnosis and treatment of synchronous multiple primary malignant tumors in lung. Methods The clinical and pathological data of 5 cases with intrapulmonary synchronous multiple primary cancer, who were diagnosed in recent 10 years in Xinhua Hospital, were retrospectively analyzed. Results The incidence of intrapulmonary synchronous multiple primary cancer was 0. 21% （5/2380） in all lung cancer cases diagnosed in respiratory department of Xinhua Hospital. There were 4 males and 1 female,with the average age of 60. 2 years old. Five patients were all treated with surgical operation. Four patients with bilateral synchronous multiple primary lung cancer underwent staging operation treatment（ larger lesions on one side of lung underwent conventional thoraceotomy and lobectomy, and smaller lesions on another side underwent thoracoscopic lobectomy or wedge resection afer 1 month）. For 1 patients with ipsilateral synchronous multiple primary lung cancer, simultaneous operation was performed. There was no death during perioperative period or severe cardiopulmonary complications. They were followed up for 3 years. The survival rate was 80. 0% （4/5） at 1 year and 60. 0% （ 3/5 ） at 3 years, respectively. Conclusions With the development of medical science and awareness of pulmonary multiple primary cancer, early diagnosis improves continuously. Active treatment with operation can achieve better prognosis.