支气管成形术治疗中心型肺癌的临床观察

目的 探讨支气管成形术治疗中心型肺癌的手术适应证及术中处理和术后并发症的防治.方法 回顾性分析2000年10月-2008年10月40例接受支气管成形术治疗的中心型肺癌患者的临床资料,其中鳞癌26例,腺癌8例,腺鳞癌4例,小细胞癌2例;Ⅰ期9例,Ⅱ期21例,ⅢA期9例,ⅢB期1例.40例中行袖状肺叶切除术37例,肺叶并主支气管楔形切除术3例,合并右肺中、上叶切除并右中间气管部分切除与右主支气管吻合1例,合并膈肌局部切除1例,合并受侵胸壁肋骨切除1例.结果 术后4例出现并发症,其中3例并发肺部感染、1例肺不张,且1例发展至心肺功能衰竭而死亡.全组随访率为92.5%（37/40）.术后1、3、5年生存率分别为81.1%（30/37）、58.3%（14/24）和33.3%（4/12）.结论 支气管成形术治疗中心型肺癌是安全可行的,并且该术式不仅能最大限度地保留正常的肺组织,还能改善患者术后的生活质量,并为少数肺功能差的患者提供了切除病变的机会.

The clinical observation of bronchial plasty in the treatment of central type lung cancer

Objective To study is to explore the appropriate admission and management of bronchoplasty and prevent complications of bronchial sleeve resection in the treatment of central pulmonary carcinoma. Methods Forty patients with central pulmonary carcinoma, who were treated with bronchoplasty from October, 2000 to October, 2008, were retrospectively analyzed. There were 26 cases of squamous cell carcinoma, 8 adenocarcinoma, 4 adenosquamous carcinoma, 2 small cell lung cancer. Nine patients were in stage I, 21 in stage II, 9 in stage IIIA and 1 in stage IIIB. There were 37 cases of sleeve lobectomy, 3 lobectomy with wedge resection of the main bronchus, 1 resection of right upper and median lobe and part of right intermedia bronchus resection with right main trachea anastomosis, 1 resection of part diaphragm, 1 resection of invasive the fibs. Results Postoperative complications happened in 4 patients. Pneumonia and atelectasis occurred in 3 cases, in which 1 died of heart and respiratory failure. Thirty-seven patients were followed up （92.5%）. The 1-, 3-, 5-year survival rate was 81.1%（30/37）, 58.3%（14/24） and 33.3%（4/12） respectively. Conclusion The bronchoplasty is safe and feasible. It can not only preserve functional pulmonary parenchyma as much as possible and improve the quality of life ＆the patients, but also provide an operative opportunity to those patients with poor pulmonary function in the treatment of central pulmonary carcinoma.