心包内处理肺血管治疗中晚期肺癌57例手术体会

目的总结心包内处理肺血管全肺切除术或肺叶切除术治疗中晚期肺癌的经验。方法回顾性分析1996年至2006年期间,57例因中晚期肺癌接受心包内处理肺血管全肺切除术或肺叶切除术患者的临床资料。结果全组患者无手术死亡,术后出现心律失常7例,肺水肿3例,肺部感染2例,均治愈。术后获得随访52例,随访率91.2%,随访时间1～5年。术后1,3,5年生存率分别为44.2%、17.3%和11.5%。结论掌握好适应证,心包内处理肺血管全肺切除术或肺叶切除术是一种安全可靠的手术方法,可明显提高中晚期肺癌的肿瘤切除率和手术安全性。     

41例心包内肺血管处理治疗中晚期中央型肺癌的临床分析

目的探讨中晚期中央型肺癌经心包内肺血管处理治疗的临床疗效。方法回顾性分析心包内处理血管的41例肺叶切除或全肺切除的临床资料。结果全组41例术后并发症发生率26.82%,1、3、5年生存率分别为67.50%、22.50%、10.00%。结论通过心包内血管处理行肺切除术治疗中晚期肺癌可增加手术切除范围并提高手术切除率,改善患者术后生活质量。     

肺癌全肺切除124例治疗总结

１９８２．１０～１９９１．１２我们行全肺切除术治疗肺癌１２４例，占同期肺癌外科治疗的１５．１％。其中心包内处理血管８８例，占７１％。手术死亡率０．８％。术后并发症３．２％，无支气管胸膜瘘发生。术后５年生存率为２７．７％，其中非小细胞癌５年生存率３５．１％，未分化小细胞癌无１例生存满５年者。晚期肺癌心包内处理血管是安全的，能提高手术切除率。对ＩＩＩ期未分化小细胞癌是否施行全肺切除，提出探讨。     

心包内全肺加左心房部分切除术治疗中心型肺癌

目的:探讨心包内全肺加左心房部分切除术治疗中心型肺癌的优点。采用双腔气管插管麻醉是手术成功的前提条件,处理肺血管是术中最危险和最重要的关键步骤。方法:用直角钳从近心端处钝性分离,不可硬行分离;如发现肺静脉内有癌栓或肿瘤直接侵及左心房壁,用两把无损伤血管钳夹闭左心房壁,既可安全处理肺静脉,又可避免静脉内癌栓脱落造成血行播散;切除部分左心房壁,近侧断端用4/Oprolene线连续往返缝合。无损伤血管钳钳夹左心房壁后应稳妥固定在胸壁上,以防突然牵拉意外致心房破裂大出血。结果:心包内处理血管的全肺切降术可提高肺癌切除率,改善生活质量,提高5年生存率;死亡率和重要并发症发生率与标准全肺切除术相比差异无显著性,生存率与标准全肺切除术亦相近,但明显优于单纯探查术。结论:采用心包内全肺加左心房部分切除术,以求彻底切除肿瘤组织,对中晚期中心型肺癌浸润肺血管根部、心包和左心房的病人,不失为一种比较积极和有效的治疗方法。     

经心包内全肺切除治疗中晚期中央型肺癌临床分析

目的探讨经心包内处理肺血管全肺切除术的手术操作、术后呼吸、血气及心功能的变化。方法回顾性分析42例经心包内全肺切除术患者的临床资料。结果42例患者术中无一例因心包切开引起不可逆性心律失常，术后并发呼吸衰竭及术后死亡均与切开心包无明显关系。结论经心包内处理肺血管全肺切除术安全性较好，可提高肺癌切除率、延长术后生存期。     

经心包内肺血管处理行肺切除术104例

从１９８５年至１９９３年间，作者采用心包内肺血管处理行肺切除术治疗Ⅲ型中央型肺癌１０４例，占同期肺癌切除术的１０％。一年生存率３５％，三年生存率１６％。作者对照以往肺手术情况，认为本方法可以提高肺切除率９．２５％，降低肺探查术近３３％。作者还就手术适应证、术式要点和手术前后处理进行讨论。     

余肺切除术治疗复发性肺癌32例分析

目的　探讨余肺切除术治疗复发性肺癌的疗效、围术期风险因素及处理方法。方法　复习 32例此类病例 ,采用生命表法计算 1、2、5年生存率。并将本组病例按某项并发症是否发生分组 ,以t检验比较各组间各项因素差异是否有显著性。结果　 17例经心包内处理血管 ;8例经胸膜外剥离径路。术中失血 40 0～ 870 0ml(平均 15 16ml )。术后心血管系并发症 12例 (循环不稳定 3例、心律不齐 9例 ) ,支气管胸膜瘘 4例 ,应激性溃疡 2例。再手术后 1、2、5年生存率分别为 88 89%、72 80 %、18 45 %。与术后并发症发生相关的因素为年龄、手术时间、余肺切除术前MVV值、余肺手术前有气急或心电图表现异常与否等。结论　对复发性肺癌的再手术治疗应持积极态度。     

中晚期肺癌心包内切除198例临床分析

目的观察心包内切除一侧全肺或肺叶治疗中晚期肺癌的疗效。方法198例中晚期肺癌行心包内全肺或心包内肺叶切除，按TNM分期，并行心肺功能检查，随访3、5、10年生存率。结果198例中晚期肺癌无一例手术死亡．心包内肺癌切除术可适当扩大适应证，使中晚期肺癌患者生存质量得到进一步改善；小细胞肺癌化疗后行心包内切除，再行化疗可取得较好的治疗效果，其3年生存率为36．7％。结论中晚期肺癌心包内切除不失为一种可靠有效的手术治疗方法。     

心包内处理血管行肺切除治疗肺癌

心包内处理血管行肺切除治疗肺癌王威方素萍李占斌王一宇贺钢枫心包内处理血管行肺切除明显提高了肺癌的切除率，减少了手术的危险性。１９８４年以来我们为７８例肺癌病人在心包内处理血管行肺癌切除，现总结报告如下：临床资料本组中男６５例，女１３例。年龄３５～６９...     

补充性全肺切除术治疗肺癌

目的　评估补充性全肺切除术的适应证、危险性和结果。　方法　回顾性分析 49例残肺恶性病变患者的补充性全肺切除术 ,其中第二原发性肺癌 14例 ,肺癌复发 35例 ;再次手术平均间隔期为 2 9个月。　结果　全组死亡6例 ,1例死于术中 ,5例死于术后 ,手术死亡率为 12 .2 4%。术后随访 1个月～ 5年 ,中位数生存时间 2 .5年 ,5年生存率为 33%。　结论　补充性全肺切除术治疗残肺癌 ,手术死亡率和术后 5年生存率接近标准的全肺切除术     

余肺切除治疗肺部疾患临床分析

目的探讨余肺切除的手术适应证、手术方法、并发症防治和远期疗效。方法回顾1985年1月至2006年8月进行的24例余肺切除[占同期全肺切除的2．3％（24／1026）]患者的临床资料。余肺切除距第1次肺切除的时间为5．5个月-30年,平均65个月;肺癌复发患者间隔时间为术后5．5个月～10年,平均32个月。手术历时4-7h,平均5．5h;术中失血300-3000ml,平均1270ml。结果手术切除23例,切除率为95．8％。术后并发症发生率及住院死亡率分别为29．2％（7／24）和4．2％（1／24）。术后病理诊断为支气管扩张症2例、原发性肺癌4例、复发性肺癌18例。术后随访率为91．7％（22／24）。肺癌余肺切除患者的1、3、5年生存率分别为77．3％（17／22）、50．0％（9／18）和29．4％（5／17）;其中复发性肺癌患者余肺切除术后的1、3、5年生存率为72．2％（13／18）、47．1％（8／17）和29．4％（5／17）。结论严格选择患者,术中精细操作,做好围手术期并发症的防治,余肺切除可有效延长患者的生存期。     

肺癌再切除术的外科疗效分析

目的 通过对60例肺癌再切除手术患者进行回顾性分析，探讨其手术特征、并发症和生存率。方法 自1980年1月至2000年10月，对60例肺癌患者实施肺癌再切除手术，余肺肺癌复发36例，第2次原发性肺癌24例。应用生命表法计算1年、3年、5年生存率。结果 全组无手术及围术期死亡，术后发生并发症26例（43．3％），涉及呼吸系统症状的21例（35％），非呼吸系统5例（8．3％），其中支气管胸膜瘘4例（6．7％），脓胸6例（10％）。随访至2000年10月，术后1年、3年、5年生存率分别为80％、68．3％和38．3％。结论 只有患者条件许可，对肺癌再切除手术应积极主动的态度。     

余肺切除术治疗再发非小细胞肺癌44例

目的 探讨余肺切除术治疗再发非小细胞肺癌的手术适应证、手术方式和预后.方法 回顾性分析肺癌再发行余肺切除术病人44例资料,采用Kaplan-Meier法计算余肺切除术后病人的1、3和5年生存率.并对相关因素进行分析.结果 围手术期死亡1例.余肺切除术后1、3和5年的生存率分别为72.73%、26.22%和18.98%.两次手术间隔时间对余肺切除术后的生存率有明显影响(P=0.019).结论 余肺切除是一项复杂的手术操作,但是经过合理选择病例,仍可取得比较满意的效果.     

Sleeve lobectomy for bronchogenic cancers: factors affecting survival

BACKGROUND: Sleeve lobectomy is a parenchyma-sparing procedure that is particularly valuable in patients with cardiac or pulmonary contraindications to pneumonectomy. The purpose of this study is to report our experience with sleeve lobectomy for bronchogenic cancer and to investigate factors associated with long-term survival. METHODS: Between January 1981 and June 2001, 169 patients underwent sleeve lobectomy for non-small-cell lung cancer (n = 139) or carcinoid tumor (n = 30), including 61 with a preoperative contraindication to pneumonectomy. Mean age was 59 +/- 14 years (range, 19 to 82 years). Vascular sleeve resection was performed in 11 patients. The remaining bronchial stump contained microscopic disease in 7 patients. RESULTS: Major bronchial anastomotic complications occurred in 6 (3.6%) patients: one was fatal postoperatively, three required reoperation, and two were managed conservatively. In the non-small-cell lung cancer group, operative mortality was 2.9% (4 of 139), and overall 5-year and 10-year survival rates were 52% and 28%, respectively. Six patients experienced local recurrence after complete resection. By multivariate analysis, two factors significantly and independently influenced survival: nodal status (N0 or N1 versus N2; p = 0.01) and microscopic invasion of the bronchial stump (p = 0.02). In the carcinoid tumor group, there were no operative deaths, and overall 5-year and 10-year survival rates were 100% and 92%, respectively. CONCLUSIONS: Sleeve lobectomy achieves local tumor control and is associated with low mortality and bronchial anastomotic complication rates. Long-term survival is excellent for carcinoid tumors. For patients with non-small-cell lung cancer, N2 disease or incomplete resection is associated with a worse prognosis; outcome is not affected by presence of a preoperative contraindication to pneumonectomy.     

Extended use of diagnostic anterior mediastinotomy: intrapericardial exploration and evaluation of resectability of left-sided bronchogenic carcinoma.

From June 1987 to June 1990, an anterior mediastinotomy with opening of the pericardium was performed in 11 patients (mean age 67.8 years) to evaluate resectability of left-sided centrally located bronchogenic carcinoma. In 3 patients (27.3%), extensive intrapericardial involvement was found which precluded complete resection. Intrapericardial extension without complete invasion of the pulmonary vessels was present in 2 patients (18.2%) who subsequently underwent an intrapericardial pneumonectomy. In 6 patients (54.5%), no intrapericardial tumour was present. There was no perioperative mortality. One patient required redrainage of the pleural cavity because of a postoperative pneumothorax. In total, 4 patients (36.4%) underwent intrapericardial pneumonectomy, 6 (54.5%) were treated by radiotherapy and 1 (9.1%) by chemotherapy. In left-sided, centrally located tumours, opening the pericardium during anterior mediastinotomy yields additional information about the degree of tumour invasion and the feasibility of performing an intrapericardial pneumonectomy. In this way, an exploratory thoracotomy is avoided and the risk of irresectability is greatly reduced.     

The risk of pneumonectomy over the age of 70. A case-control study.

OBJECTIVE: A higher mortality has been reported after pneumonectomy over the age of 70. The aim of the study was to quantify the additional risk due to age after standard pneumonectomy for lung cancer by a case-control study. METHODS: Our clinical database was reviewed to search for patients aged 70 years or more who underwent standard pneumonectomy for lung cancer between 1998 and 2005. A control group of patients younger than 70 (one case/two controls) was matched for sex, cardiovascular disease, American Association of Anaesthetists score, respiratory function, side of pneumonectomy, induction chemotherapy and stage. Overall mortality and morbidity were compared. Long-term survival data were also analysed. RESULTS: During the considered period, 35 patients aged 70 years or more underwent pneumonectomy (30 males, median age 73 years, 15 right-sided procedures). The control group was composed of 70 patients. The two groups were homogeneous in the variables used for matching. Overall mortality and morbidity were 11.4 and 54.2% in the elderly group as compared to 4.3 and 41.6% in controls (p-value not significant). Elderly patients experienced a higher rate of respiratory complications (25.7%) as compared to controls (8.3%, p=0.01). At univariate analysis, the only risk factor for death was the occurrence of respiratory complications (OR 6.5, CI 1.8-18.2). At multivariate analysis, age >or=70 years (OR 5.36, CI 1.48-19.3) and preoperative chemotherapy (OR 7.65, CI 2.04-28.6) were confirmed as predictors of respiratory complications. Five-year survival was 17.5% in the elderly group and 53.6% in the control group (p=0.003). Elderly patients with a better respiratory function (FEV1>70%) had a 5-year survival of 45.4%. CONCLUSIONS: In the elderly patients, the risk of respiratory complications after pneumonectomy is increased as compared to younger patients with equivalent respiratory function. Age and preoperative chemotherapy are independent risk factors for respiratory complications. A lower mortality and a better long-term survival are obtained in elderly patients with a better respiratory function (FEV1>or=70%).     

Combined Resection of Great Vessels or the Heart for Non-Small Lung Cancer

Objectives: The surgical indications for non-small cell lung cancer (NSCLC) infiltrating a great vessel or the heart are controversial. We assessed clinical features and surgical outcomes of patients with non-small cell lung cancer who underwent combined resection of a lung and great vessel.Methods: Fourteen patients underwent great vessel resection under a lobectomy (n = 9), sleeve lobectomy (n = 2), or pneumonectomy (n = 3) between 2000 and 2011, in whom the aorta was resected in 6, superior vena cava in 5, right atrium in 1, and left atrium in 2. The histological types were adenocarcinoma (n = 8) and squamous cell carcinoma (n = 6).Results: Complete resection was performed in 12 patients. Of all patients, 7 had pN0 disease, 2 had pN1, and 4 had pN2. The postoperative morbidity rate was 28.6% and mortality rate was 7.1%. The 5-year survival rate was 26.8% for all patients, 46.9% for those with an adenocarcinoma, 0% for those with a squamous cell carcinoma, 53.6% for those with pN0, and 0% for those with pN1-2.Conclusion: Resection of the great vessels and heart involved by NSCLC can be performed with acceptable morbidity and mortality, and results in prolonged survival in patients, with an adenocarcinoma or N0 status.     

Subsequent pulmonary resection for bronchogenic carcinoma after pneumonectomy

BACKGROUND: Patients who have undergone a pneumonectomy for bronchogenic carcinoma are at risk of cancer in the contralateral lung. Little information exists regarding the outcome of subsequent lung operation for lung cancer after pneumonectomy. METHODS: The records of all patients who underwent lung resection after pneumonectomy for lung cancer from January 1980 through July 2001 were reviewed. RESULTS: There were 24 patients (18 men and 6 women). Median age was 64 years (range, 43 to 84 years). Median preoperative forced expiratory volume in 1 second was 1.47 L (range, 0.66 to 2.55 L). Subsequent pulmonary resection was performed 2 to 213 months after pneumonectomy (median, 23 months). Wedge excision was performed in 20 patients, segmentectomy in 3, and lobectomy in 1. Diagnosis was a metachronous lung cancer in 14 patients and metastatic lung cancer in 10. Complications occurred in 11 patients (44.0%), and 2 died (operative mortality, 8.3%). Median hospitalization was 7 days (range, 2 to 72 days). Follow-up was complete in all patients and ranged between 6 and 140 months (median, 37 months). Overall 1-, 3-, and 5-year survivals were 87%, 61%, and 40%, respectively. Five-year survival of patients undergoing resection for a metachronous lung cancer (50%) was better than the survival of patients who underwent resection for metastatic cancer (14%; p = 0.14). Five-year survival after a solitary wedge excision was 46% compared with 25% after a more extensive resection (p = 0.54). CONCLUSIONS: Limited pulmonary resection of the contralateral lung after pneumonectomy is associated with acceptable morbidity and mortality. Long-term survival is possible, especially in patients with a metachronous cancer. Solitary wedge excision is the treatment of choice.