原发中叶肺癌的临床特点与手术治疗

目的探讨中叶肺癌的临床表现特征与外科治疗特点，提高中叶肺癌的诊断率与生存率。方法回顾分析外科治疗的106例中叶肺癌临床资料。结果主要症状：咳嗽62例,咳痰带血48例，发热29例，胸闷、胸痛16例，关节痛8例。术前抗炎超过1个月30例，抗结核治疗9例。确诊日期：1个月内64例，1～6个月25例，7～12个月13例，13～18个月4例。手术结果：剖胸探查3例；切除103例，其中中叶切除32例，中下叶切除51例，中上叶切除13例，右全肺切除7例。清扫N1淋巴结333组，N2淋巴结378组。右肺下动脉侧壁切除5例，动脉袖状切除2例。1例术后呼吸衰竭死亡。术后病理及分期：单纯pN1阳性8例，pN2阳性6例，pN1+pN2阳性21例。pⅠ期14例, pⅡ期34例，pⅢA期51例，pⅢB期3例,pⅣ期1例。随访：97例被随访者平均5年生存率29.9%。结论中叶肺癌易误诊为炎症、结核，应注意及时合理检查，力求及时确诊。由于解剖特点，手术常需联合肺叶切除，廓清上、下纵隔淋巴结是手术根治的关键。

Clinical features and surgical treatments for primary middle lobe carcinoma of the lung

To investigate the features of clinical performances and surgical treatments for patients with primary middle lobe lung carcinoma so as to enhance the diagnostic and survival rate. MethodsThe clinical data and therapeutic results of 106 patients with middle lobe lung cancer who had undergone surgical treatment were retrospectively studied. ResultsThere were 62 patients with cough, 48 with bloody sputum, 29 with fever, 16 with chest pains and 8 with joint pains. Thirty patients were subjected to anti inflammatory treatments for more than 30 days and 9 anti-tuberculosis treatments. Sixty four cases were diagnosed within 1 month, 25 within 1 to 6 months, 13 within 7 to 12 months and 4 within 13 to 18 months. Three patients underwent exploratory thoracotomy and 103 patients underwent resection including middle lobectomy in 32 patients, middle-lower lobectomy in 51, middle upper lobectomy in 13, and right pneumonectomy in 7. Altogether 333 N1 and 378 N2 lymph nodes were cleared up. Five patients underwent lateral wall resection of the right lung lower artery and 2 patients underwent artery sleeve resections. One patient died of respiratory failure after the operation. Based on pathologic results, positive lymph nodes of PN1 were identified in 8 cases, PN2 in 6 cases, and both PN1 and PN2 in 21 cases. There were 14 cases in pathological stage I, 34 cases in pathological stage Ⅱ, 51 cases in pathological stage ⅢA, 3 cases in pathological stage ⅢB and 1 case in pathological stage Ⅳ. Follow up: The 5 year survival rate of the 97 patients was 29.9%. ConclusionsMiddle lobe pulmonary carcinoma sometimes is misdiagnosed as inflammation or tuberculosis, so a reasonable check up should be performed in time to make a final diagnosis. Because of the anatomic features of middle lobar bronchus, lobectomy in combination with clearance of the mediastinal lymph node should be performed.