人工血管转换上腔静脉在肺癌外科治疗中的应用

目的探讨分析上腔静脉切除行人工血管转换在晚期肺癌外科治疗中的作用、技术方法及其预后。方法全组共２６例,右侧中心型肺癌２１例、周围型肺癌５例,行肺癌原发病变、转移淋巴结及受侵及的上腔静脉切除,采用人工血管转换切除的上腔静脉。术后口服小剂量抗凝剂的短期治疗,并进行长期的随访与观察。结果 全组无术中及术后早期死亡,无术后近期及远期上腔静脉及无名静脉梗阻症状的发生。随访２３例,１、３、５年生存率分别为８４     

肺癌侵及隆突的外科治疗

目的：总结肺癌侵及隆突的外科治疗，研究分析其手术适应证、技术方法及术后管理。方法：全组病例共36例，右肺中心型肺癌25例，右侧纵隔型肺癌2例，其中侵及上腔静脉及无名静脉6例；左侧中心型肺癌9例；手术方式：行右隆突全肺或肺叶切除隆突重建术27例，6例同时行受侵上腔静脉及无名静脉切除人工血管置换；左隆突全肺切除9例。结果：全组无手术死亡，术后早期死亡4例（11．1％），循环衰竭3例，呼吸衰竭1例；1年生存率80．6％（29／36），3年生存率47．4％（9／19），5年生存率33．3％（3／9）。结论：对于肺癌侵犯隆突和上腔静脉及双侧无名静脉通过切除原发病变和部分受侵器官可达到临床根治之目的，辅于多学科的综合治疗，患者亦可获得良好的远期生存。     

血管外科技术在胸部肿瘤外科中的应用

目的　探讨上腔静脉及无名静脉切除 ,人工血管置换术在胸部肿瘤外科治疗中的应用及其临床效果。方法　实验研究 :健康成年犬 18只 ,分为单纯阻断组 :阻断上腔静脉或上腔静脉奇静脉联合阻断 (9只 ) ;人工血管置换组 :切除上腔静脉 ,行人工血管置换 (9只 )。对上腔静脉阻断前后上腔静脉压力的变化、人工血管置换后的病理改变、抗凝治疗及长时间阻断上腔静脉后脑组织的病理改变进行分析。临床研究 :胸部肿瘤患者 56例 ,其中肺癌 42例 ,纵隔肿瘤 14例。行肿瘤根治切除术及受侵上腔静脉和 (或 )无名静脉切除人工血管置换 ,并对患者进行长期随访。结果　实验研究 :实验犬上腔静脉加奇静脉阻断后 ,上腔静脉系统压力为 (49 2 8± 14 72 )cmH2 O(1cmH2 O =0 0 98kPa) ,高于单纯上腔静脉阻断的 (3 7 83± 1 3 5)cmH2 O (P <0 0 5) ;腔静脉阻断 2h未见脑实质充血及水肿 ;人工血管置换组犬术后 1个月血管腔内壁已有纤维素沉积 ,2个月始有部分血管内皮细胞移行覆盖 ;未应用抗凝治疗情况下血管无附壁血栓形成。临床研究 :全组患者无围手术期死亡及术后近、远期上腔静脉系统梗阻症状。肺癌组患者 1、3、5年生存率分别为 84%、41%、3 9% ;纵隔肿瘤患者术后 1例死亡。结论　血管外科技术的应用 ,扩大了胸部肿瘤外科手     

心房或大血管部分切除在局部晚期肺癌手术中的应用

目的探讨肺叶或全肺切除合并左心房或大血管部分切除治疗局部晚期肺癌的价值。方法回顾性总结我科在2005年2月-2008年9月间,采用部分心房或大血管切除治疗26例局部晚期肺癌（T4N0-N2M0）病例。左全肺及左心房部分切除12例,左全肺及肺动脉干部分切除2例,右全肺及左心房部分切除9例,（其中2例在体外循环辅助下进行）,右肺中下叶及部分左心房切除1例,右上肺叶及上腔静脉部分切除人工血管置换2例。结果本组26例患者,无手术死亡病例,术后仅有3例发生心律失常,占11．54％（3／26）。1年生存率为77．8％（14／18）,2年生存率为55．6％（5／9）。术后病理分型：鳞癌23例,腺癌1例,大细胞癌2例,T4N0M0者3例,T4N1M0者7例,T4N2M0者16例。结论侵及心房或大血管的局部晚期肺癌（Ⅲb期）采用扩大切除术能提高根治性手术切除率,改善患者生活质量,提高局部晚期肺癌生存率,在临床上有应用价值。     

34例局部晚期非小细胞肺癌的外科治疗经验

目的探讨局部晚期非小细胞肺癌的外科治疗效果。方法外科治疗局部晚期非小细胞肺癌34例,其中肺切除加部分胸壁切除9例,右全肺切除加隆凸成形6例、左全肺切除加隆凸成形4例、右上肺叶切除加上腔静脉部分置换1例,右全肺切除加上腔静脉部分切除＋成形5例,左全肺切除加主动脉部分切除成形3例、左全肺切除加部分左心房切除6例。结果全组病例围手术期无死亡,鳞癌21、腺癌13例,术后并发乳糜胸2例,肺不张2例,心率失常4例,喉返神经损伤3例。术后随访时间6—62个月,平均27．3个月,其中1、3、5年生存率分别为82．4％、38．2％、8．8％。结论扩大手术治疗局部晚期非小细胞肺癌可以达到肿瘤的根治切除,并能延长患者的生存时间,但是要严格把握手术指征。     

老年原发性肺癌的外科治疗

本文报道自１９７５年１月～１９９４年１２月我院收治的７６例７０岁以上原发性肺癌外科治疗结果。肺叶切除５７例，袖状肺叶切除９例，肺楔形切除７例，全肺切除３例。发生并发症占２７．６％（２１／７６），１例术后５天死于呼吸衰竭，手术死亡率为１．３％。作者认为对７０岁以上原发性肺癌外科治疗，应选择无严重心肺功能障碍的Ⅰ、Ⅱ期非小细胞肺癌患者，以肺叶切除术为首选术式。术后应重视血氧饱和度监测，及时发现和处理低氧血症。本组术后３年生存率为３８．２％（２９／７６），５年生存率为３１．６％（２４／７６），１０年生存率为１８．４％（１４／７６），提示对老年原发性肺癌患者采取积极的外科治疗亦可以取得较好的疗效。     

Ⅲa期蛎小细胞肺癌综合治疗的远期效果

对１９７９年至１９９１年底手术切除的７８８例Ⅲａ期非小细胞肺癌（ＮＳＣＬＣ）的治疗结果进行分析。同时，将全组中３１６例综合治疗与４７２例单纯手术病例进行对比。全组５年生存率１５．３％，其中综合治疗组２３．０％，单纯手术组１０．０％。综合治疗组５年生存中麟癌占２６．６％，腺癌２２．８％；单纯手术组５年生存率中鳞癌１４．１％，腺癌９．９％。结果显示：综合治疗组生存率高于单纯手术组。因此，综合治疗应成为     

侵犯邻近脏器的70岁以上肺癌患者的外科治疗

日本癌症研究所附属医院积14年经验,对侵犯邻近脏器的70岁以上肺癌患者进行临床研究。全组29例均作肺切除及合并受侵脏器切除术,收到一定疗效。资料1970～1983年的14年间收治原发性肺癌781例,外科治疗394例,手术切除的70岁以上者103例,其中伴邻近脏器受侵者29例。为了专题研究高龄晚期肺癌病人的外科治疗,作者将伴邻近脏器受侵的肺癌患者分为70岁以上高龄组(Ⅰ组)29例和70岁以下对照组(Ⅱ组)85例。各种肺切除合并邻近脏器切除:Ⅰ组有壁层胸膜     

Ⅲa期非小细胞肺癌综合治疗的远期效果

对胸外科１９７９至１９９１年底手术切除的７８８例Ⅲａ期非小细胞肺癌（ＮＳＣＬＣ）的治疗结果进行分析。同时，将全组中３１６例综合治疗与４７２例单纯手术病例作对经丛组５年生存率１５．３％，综合治疗组５年生存率２３．０％，单纯手术组５年生存率１０．０％。综合治疗组５年生存率：鳞癌２６．６％，腺癌２２．８％。单纯术手术组５年自下而上率：鳞癌１４．１％，腺癌９．９％。本文分析表明：Ⅲａ期ＮＳＣＬＣ综合治疗住     

肺癌合并上腔静脉综合征的外科治疗

对１０例右肺癌侵及上腔静脉造成上腔静脉综合征（ＳＶＣＳ）的患者行肺切除并上腔静脉置换或旁路术，效果良好，认为合并ＳＶＣＳ的肺癌患者在无远处转、内脏器官功能良好的情况下，应积极手术解除上腔静脉梗阻，并就手术指征方法、术后处理的问题进行了讨论。     

Surgical treatment and adjuvant chemotherapy in hepatocellular carcinoma patients with advanced vascular involvement

BACKGROUND/AIMS: In advanced hepatocellular carcinoma (HCC) with vascular involvement of major vessels, patients have a poor prognosis after surgical treatment. METHODOLOGY: Patient outcomes after surgical resection and the usefulness of adjuvant chemotherapy were examined in 12 patients with major hepatic vessel involvement who underwent hepatectomy with combined resection of major blood vessels. RESULTS: The main portal vein was resected in 8 patients, the inferior vena cava in 3, hilar bile duct in 2 and hepatic artery in 1. Eleven patients underwent hemihepatectomy and 1 underwent segment 4 and 5 resection. The portal branch was repaired by venoplasty. The vena cava wall was repaired by suture closure. The hepatic artery was replaced by end-to-end anastomosis. The bile duct was repaired by Roux-en-Y hepaticojejunostomy. Although 2 patients had biliary leakage, there were no postoperative complications in 10 patients. The tumor recurrence rate was 83% in the early period and cancer death within 1 year was observed in 6 (50%), while 3 with tumor recurrence survived for more than 2 years and 2 survived without recurrence. In 233 HCC patients who underwent hepatectomy, 10 patients including 2 present cases received adjuvant chemotherapy at the time of tumor recurrence and 2 had complete responses. While in 11 patients receiving chemotherapy without resection, the response rate using Gemcitabine (66%) was higher than that using low dose Cisplatin plus 5-Fluorouracil (22%). CONCLUSIONS: Complete surgical resection combined with main vascular resection could be safely performed in most advanced stage HCC patients and adjuvant chemotherapy in the early period after resection would be necessary, which may achieve longer survival in some patients even in the advanced stage.     

以磨玻璃样密度影为表现的早期肺癌并发肺结核患者的诊治分析

目的 分析以磨玻璃样密度影(ground-glass opacity,GGO)为表现的早期肺癌并发肺结核患者的临床特点,以达到早期识别及治疗的目的。方法 对山东大学附属山东省胸科医院自2013年1月至2018年2月确诊的14例以GGO为首要表现的肺癌并发肺结核患者的临床表现、CT扫描征象、手术方式、病理类型等进行回顾性分析。结果 以GGO为表现的早期肺癌并发肺结核以查体时发现多见(9/14),CT表现为陈旧性结核病灶并发混合密度GGO(mGGO) 12例;GGO与结核病灶位于同侧同叶4例。术前对患者进行规范抗结核药物治疗9例,术后继续行规范抗结核药物治疗6例。术前有3例患者行CT引导下肺穿刺活检确诊肺癌,其余11例为术中冰冻切片病理检查证实。行肺叶切除加纵隔淋巴结清扫10例,肺叶(GGO病灶所在处)切除加同侧异叶肺结核瘤局部切除2例,肺段切除1例,楔形切除1例。肺结核病灶标本经病理检查确诊10例,另4例依据病史及影像学表现符合陈旧性肺结核诊断;表现为GGO的早期肺癌病灶标本经病理检查确诊腺癌11例,鳞癌1例,腺鳞癌1例,大细胞癌1例。纵隔淋巴结病理检查均未见转移。本组患者术后均顺利康复,短期随访未见肿瘤复发、转移及结核复燃等。结论 GGO为表现的早期肺癌并发肺结核患者其临床表现无特异性,薄层CT扫描加动态观察有利于诊断。手术方式需在肺癌切除的基础上兼顾结核病灶的处理,规范的抗结核药物治疗加手术切除治疗效果满意。     

风湿性心脏病瓣膜置换术216例临床分析

目的总结216例风湿性心脏病的外科治疗经验。方法手术在全麻体外循环中度低温下进行,其中行二尖瓣置换术（MVR）130例,主动脉瓣置换术（AVR）28例,二尖瓣、主动脉瓣双瓣置换术（BVR）58例,三尖瓣成形术71例,左心耳结扎术24例,左房折叠术10例,左房血栓清除术25例。结果209例（96．8％）恢复出院,早期死亡7例（3．2％）,死囚分别为低心排综合征2例、左室后壁及主动脉后壁破裂出血各1例、多脏器功能衰竭1例、恶性心律失常1例、脑栓塞1例。结论瓣膜置换术是治疗风湿性心脏瓣膜病的有效手段。充分的术前准备、加强心肌保护、提高和改进手术技术、术后有效的监护治疗,可显著提高手术疗效,减少术后并发症,降低死亡率,取得满意的临床效果。     

Liver resection in advanced hepatocellular carcinoma

BACKGROUND/AIMS: The aim of this study was to assess the results of major liver resection in patients with advanced hepatocellular carcinoma in terms of safety and survival. METHODOLOGY: The subjects of this study are 19 patients that underwent 24 resections for advanced (stage IV) hepatocellular carcinoma. Eighteen of these resections were performed for primary tumor and 6 were repeat resections. Nine patients presented without cirrhosis, 5 with cirrhosis, and 5 patients had the fibrolamellar variant of hepatocellular carcinoma. RESULTS: Hospital mortality was recorded in 1 case (5%). Morbidity was noted in 7(37%) cases. All patients with fibrolamellar variant of hepatocellular carcinoma are alive at 78, 41, 24, 12 and 9 months (P = 0.008), compared with a median survival of 18 and 9 months for the noncirrhotic hepatocellular carcinoma and cirrhotic hepatocellular carcinoma groups, respectively (P = 0.24). CONCLUSIONS: We conclude that an aggressive policy of major liver resection with vascular reconstruction was justifiable in patients with advanced fibrolamellar variant of hepatocellular carcinoma and in selected patients with noncirrhotic hepatocellular carcinoma, and of doubtful value in patients with cirrhosis.     

Lymphoepithelioma-like carcinoma of the lung

Lymphoepithelioma-like carcinoma (LELC) of the lung was first reported in 1987. In the past two decades, there have been just more than 150 cases reported in the literature. This uncommon but distinct form of non-small cell lung carcinoma has a predilection for young non-smoking Asians, without gender distinction. Histologically, it is indistinguishable from undifferentiated nasopharyngeal carcinoma. The carcinogenic role of latent Epstein-Barr virus infection in causing LELC of the lung has been evident almost exclusively in Asians compared with Caucasians. Among the reported cases, more than half were in early resectable stages (I or II) and there was a tendency for peribronchovascular spread with vascular encasement in advanced diseases. In order to establish the diagnosis of LELC of the lung, both nasopharyngeal carcinoma and lymphoma have to be excluded by endoscopic biopsy (with or without magnetic resonance imaging of the nasopharynx) and immunohistochemical staining of the biopsy samples. The mainstay of treatment for early-stage disease is curative surgical resection, whereas multimodality treatment (surgery, chemotherapy, radiotherapy) has been adopted in advanced or metastatic diseases. The overall survival is more favourable in LELC of the lung compared with non-LELC type of non-small cell lung carcinoma. Future collaborative studies especially on optimizing treatment for this uncommon malignancy are clearly warranted.     

Prognosis and recurrent patterns in bronchioloalveolar carcinoma

STUDY OBJECTIVE: Bronchioloalveolar carcinoma (BAC) is an uncommon pulmonary neoplasm with various radiologic and clinical presentations. In this article, we analyze the initial radiologic findings, TNM stagings, surgical types, and radiologic features of recurrence, and correlate them with patient survival. DESIGN: A retrospective review of 93 patients who underwent resection for BAC from February 1989 to May 1999. PATIENTS: There were a total of 153 patients with BAC diagnosed during this period. Among them, 60 patients (39.2%) had diffuse disease and received medical therapy only, and the remaining 93 patients (60.8%), who had localized disease, underwent surgical resection. Patients who received surgical resection were enrolled in this study. MEASUREMENTS: Data regarding demographics, presentation symptoms, initial radiologic features, surgical type, tumor staging, recurrence status, radiologic patterns of recurrence, and survival were obtained from all patients. RESULTS: Female patients were significantly younger than male patients. Patients who were female, nonsmoking, undergoing curative surgery, lobectomy, or bilobectomy, and with early tumor staging and no nodal involvement had a better prognosis. Patients with a right lung tumor had a longer survival than those with a left lung tumor, with borderline significance. Among those who suffered from recurrent diseases, a second resection yielded a better survival. Multivariate analysis showed curative surgery, initial surgical type, recurrence status, radiologic patterns of recurrence, and duration from surgical resection to recurrence all had a significant impact on survival. CONCLUSIONS: Those patients with localized, early-stage BAC who underwent curative surgery had a better survival. Patients with localized recurrence after the initial surgery warranted a second resection. Those with a diffuse radiologic pattern of recurrence and/or early recurrence had a worse prognosis.     

Significance of superior vena cava reconstruction with EPTFE grafts in the surgical treatment of superior and anterior mediastinal invasive malignant tumors

The objective of this study is to demonstrate the significance of superior vena cava (SVC) reconstruction in the surgical treatment of superior and anterior mediastinal invasive malignant tumors, by using a total of 48 cases consisting of 36 invasive thymomas, 3 thymic cancers, 3 carcinoids, 2 germ cell tumors, 2 malignant lymphomas, 1 intrathoracic thyroid cancer and 1 malignant melanoma. In 22 of 48 cases there was only mediastinal pleural invasion or tumor capsule invasion, on the other hand, 26 cases had high ratios of invasion to adjacent organs, including lung, pericardium, great veins and the phrenic nerve. Sixteen of 26 cases had invasion to 1-2 adjacent organs, but 10 had 3-6 organ invasion. Among 12 cases invading SVC or brachiocephalic veins, 9 cases during the last 7 years underwent SVC resection and reconstruction with EPTFE grafts. The patency was good in the grafts with external ring support and no SVC symptoms were observed in all cases postoperatively. The longest patent and functional graft is 40 months postoperative. No statistically significant difference were demonstrated in the survivals between cases with SVC reconstruction and those with resections of other adjacent organs, furthermore, remarkable difference of survival was demonstrated in SVC reconstructed cases with complete resection and incomplete resection. The survivals in cases with combined resection of 1-2 adjacent organs was statistically significantly better than those with combined resection of 3-6 adjacent organs (p less than 0.05, Cox-Mantel test).(ABSTRACT TRUNCATED AT 250 WORDS)