支气管成形术治疗肺癌20例

目的探讨支气管成形术治疗肺癌的适应证、手术方法及注意事项。方法 2000年1月—2010年12月应用支气管成形术治疗肺癌20例,其中男15例,女5例;年龄48～75岁,平均62岁;左肺上叶支气管袖状切除5例;右肺上叶支气管袖状切除8例;右肺上中叶支气管袖状切除3例;左肺上叶支气管及左肺动脉双袖状切除2例;右肺上叶支气管袖状及右肺动脉侧壁切除成形2例。术后病理诊断：鳞癌14例,腺癌3例,小细胞癌2例,腺样囊性癌1例。结果无手术死亡,未发生支气管胸膜瘘、大咯血、脓胸等其他严重并发症。结论支气管成形术已成为治疗中心型肺癌的首选术式,但必须严格掌握其适应证、熟练掌握操作方法及注重术后处理。     

气管、支气管袖状切除术

气管、支气管袖状切除是治疗气管、支气管的良性疾患、低度恶性肿瘤和修复气道损伤或狭窄的理想手术方法。也适用于经过选择的气管癌和部分中心型支气管肺癌的病人,因对心肺功能影响较少,其生存期比全肺切除病人的生存期长。本文报道21例气管、支气管袖状切除术,病理证实为癌肿的15例。良性肿瘤4例、外伤性气管、支气管断裂各1例。文中对手术的适应证、禁忌证,手术前的准备,麻醉问题,手术操作技术,手术后的处理等的体会,结合文献进行讨论。本组21例无手术死亡率,亦无发生术后的并发证,说明此类手术是比较安全的,近期效率良好。我们认为对经过选择的一部分中心型肺癌的病人,采用肺叶支气管袖状切除术,能最大限度地清除病灶和保留健肺,避免全肺切除,这对年老和肺功能较差的病人是有重要意义的。本组对肺癌病例术后均进行随访,初步印象:肺叶支气管袖状切除术的效果是不逊于全肺切除术。     

外科治疗慢性脓胸67例的体会

本文报告67例慢性脓胸根治术,其中以胸膜纤雉板剥除术为主,占本组病例的68.6％。并强调肺松解术能扩大胸膜纤雄板剥除术的适应证。在充分肺松解的基础上,有7例胸膜肺切除(肺叶切除4例,肺部分切除8例),4例支气管胸膜瘘修补术,均获得成功。     

脓胸扩清纤维板剥脱术在脓胸治疗中的应用

本文介绍了36例脓胸病人采用脓胸扩清、纤维板剥脱术,其中一例扩清术加肺下叶切除,一例扩清术加大网膜移植及部分胸改术。本组病例有35人经一次手术治愈。另一例多发性支气管胸膜瘘,扩清术后做胸腔闭式引流,再次经胸内大网膜移植加部分胸廓整形术而治愈。     

非小细胞肺癌术后支气管切缘癌对预后的影响

目的:为了探讨非小细胞肺癌术后支气管切缘癌的发生及预后特点,优化处理方案,提高5年生存率。方法:1997年初～2004年底10年间经手术切除893例非小细胞肺癌,显微镜下发现支气管残端癌阳性者89例,配以同期根治性肺癌切除574例进行发病及生存的对比分析。结果:发现非小细胞肺癌术后支气管切缘癌的发生率与不同的肺切除术式,病理学类型及PTNM分期无关。结论:但预后以鳞癌最好,并依PTNM分期的增加生存率逐渐下降。术后辅以放疗和化疗为主的综合治疗对延长病人的生存期有重要意义。     

支气管成形术治疗支气管肺癌18例

支气管成形术治疗肺癌１８例。其中支气管袜状切除１０例，支气管楔形切除４例，支气管袖状并肺动脉肺袖状切除４例；６例行术前半量放疗。结果无１例出现心肺并发症，无围手术期死亡。术后３年，５年生存率分别为５３．３％和４２．９％。     

肺叶支气管袖状切除术治疗中央型肺癌

目的 探讨肺叶支气管袖状切除术治疗中央型肺癌的方法和疗效。方法 自1993年6月至2000年12月共施行肺叶加支气管袖状切除治疗中央型肺癌39例。左上肺叶6例,左下肺叶3例,右上肺叶25例,右中下肺叶5例。同时联合动脉成型术5例。绝大多数为Ⅱ期及Ⅲa期患者。结果1个月内无死亡,术后1,2,3,5年生存率分别为90％,71％,52％,44％。术后无吻合口瘘,亦无吻合口狭窄。结论 此种术式能达到最大限度保持清除病灶和保留肺功能,可获得与一侧全肺切除同样彻底的效果,其生存期比全肺切除生存期长。     

改良胸改术──骨膜下肋骨断段术治疗慢性脓胸支气管胸膜瘘的体会

我院外科于1988年6月始，采用改良胸改术──骨膜下肋骨断段术治疗慢性脓胸支气管胸膜瘘17例。手术后经随访3个月至33个月疗效满意．现报告如下。临床资料本文报道17例慢性脓胸支气管胸膜疾。男性8例，女性9例。年龄最小16岁，大者56岁、病程短者4个月，长者达15年、15例为结核性脓胸，2例为混合性脓胸。17例中有1例曾经胸膜纤维板副脱术后肺膨胀不佳而遗有残腔；另1例大网膜充填术。术后因大网膜部分坏死脱落残腔没有消灭。另1例脓胸右上叶毁损肺纤维板剥脱术加右上叶切除，术后感染至支瘘而行闭式引流术。2例施全肺切除，术后8个月形成晚…     

肺叶切除加气管支气管成型术的麻醉处理七例

我院1995－1996年在肺癌病人中应用静脉复合麻醉行肺叶切除加气管、支气管成型术7例，现报道如下：1临床资料本组7例均为男性，年龄45－62岁，平均50．7岁。左肺中心型肺癌2例，左肺上叶癌2例，右肺上叶癌1例，右肺下叶癌1例，右肺中心型肺癌1例。左肺上叶切除加气管、支气管成型术4例，右肺上叶切除加气管、支气管成型术1例，右肺下叶切除加气管、支气管成型术2例。7例术前有心电图异常3例。麻醉选用硫喷妥钠、安定、芬太尼、司可林快速诱导，插入Robertshaw双腔支气管导管，通过听诊双肺呼吸音，仔细调整支气管导管位置，使患侧肺完全不…     

23例气管、支气管内恶性肿瘤外科治疗

目的 总结1980—1999年23例气管、隆凸、支气管内恶性肿瘤病人手术和手术效果进行探讨。方法 行气管、主支气管袖状切除对端吻合术15例，隆凸切除成形术8例。结果 2例术后咳痰困难，肺内感染合并呼衰死亡，1例术后吻合口漏气并发脓胸死亡，随访时失访1例。余者1年生存率79．1(15／19)，3年生存率49．2(9／12)，5年生存率31．4％(6／19)。结论 支气管、隆凸成形术可以扩大肺癌的手术适应征，最大限度地保存肺功能。手术比较复杂，操作有一定难度，要严格掌握手术适应征，可以取得满意的疗效。     

肺叶袖状切除、肺动脉成形术治疗支气管肺癌

目的 研究肺叶袖状切除,肺动脉成形术治疗支气管肺癌的疗效。方法 回顾性总结58例支气管肺癌手术治疗,其中51例行主支气管袖状肺叶切除成形术,7例行主支气管及肺动脉双袖状切除成形术。结果 4例患者术后1a肿瘤复发,1例术后4a复发,分别再次手术,53例术后随访1,3,5年生存率分别为78％（42／53）,52％（24／46）和47％（16／34）,结论 肺叶袖状切除,肺动脉成形术治疗支气管肺癌既可全部切除肿瘤,又能最大限度保留正常肺组织,改善术后患者的生成质量,远期疗效良好,可作为外科治疗肺癌的常规术式之一。     

支气管成形术治疗肺癌的远期临床观察

目的 评价支气管成形术在外科治疗肺癌中的价值。方法 作者从1976年8月至2002年12月采用支气管成形术及血管成形术治疗肺癌共计78例,病理类型以鳞癌居多,为67例(86％)。右肺上叶袖状切除57例,其中2例同时行血管成形,2例同时行隆凸部分切除;右肺中上叶袖状切除1例;右肺中下叶袖状切除2例。左肺上叶袖状切除12例,其中3例同时行左肺动脉袖状切除或成形术;左肺下叶袖状切除5例。术后病理分期：期47例(60．2％),Ⅱ期23例(29．5％),Ⅲ期8例(10.3％)。结果 本组术后30d内无死亡病例,术后早期并发症5例(6．6％),其中肺炎2例,肺不张3例,术后5年及10年生存率分别为57．8％(26／45)、43％(6／14)。Ⅰ期、Ⅱ期及Ⅲ期病例的5年生存率分别为68．7％(22／32)、36．4％(4／11)及0(0／2)。结论 支气管成形术,可使部分高龄及肺功能不全的肺癌患者获得外科手术机会,并可改善患者术后生活质量,提高治愈率。     

多原发肺癌（12例报告）

目的：探讨多原发肺癌的诊断及手术治疗。方法：对12例诊断为多原发肺癌患的临床病理资料进行分析。男9例，女3例。同时性双原发肺癌5例，异时性双原发肺癌7例。12例按肿瘤不同的生长部位采取不同的手术方式，9例采用规范的肺叶切除术；3例因肺功能差行肿物切除术。结果：本组无手术死亡，均获得随访，存活1年8例，存活3年4例，存活5年1例，现有2例仍在随访中。结论：手术切除为多原发肺癌的主要治疗方法。     

气管支气管成形术在肺癌治疗中的应用

目的探讨气管、支气管成型术治疗肺癌的手术适应证、手术方法、术后并发症及临床疗效。方法总结1988年6月～2009年4月采用气管、支气管成型术治疗的112例肺癌患者的临床疗效,并对其安全性及并发症等进行分析。结果术后7例并发肺部感染、肺不张,且2例因心肺功能衰竭而死亡;出现心律失常3例。全组患者术后1、3、5年生存率分别为81.9%(86/105例)、54.5%(36/66例)和39.6%(19/48例)。结论气管、支气管成形术可使部分高龄及肺功能不全的肺癌患者获得外科手术机会,在根除病变的同时改善术后生活质量,有利于延长生存期。     

Diagnostic yield of broncho-alveolar lavage fluid and postbronchoscopic sputum cytology in endoscopically non-visible lung cancers

Diagnostic yield of broncho-alveolar lavage (BAL) fluid and postbronchoscopic sputum (PBS) cytology is very high in endoscopically visible bronchogenic carcinoma, but they are also helpful in diagnosis of those lung cancers which are not visible bronchoscopically. Objective of this prospective study is to analyse the diagnostic yield of BAL fluid and PBS cytology in endoscopically non-visible lung cancer. Thirty patients with chest radiographic abnormality suspicious of lung cancer without endobronchial abnormality underwent BAL fluid and PBS cytology examination in the department of respiratory medicine of Calcutta National Medical College and Hospital over 1 year and 3 months. The final diagnosis was bronchogenic carcinoma in 21, tuberculoma/tuberculosis in 5, bacterial pneumonia in 3 and encysted empyema in 1. Among the 21 patients with bronchogenic carcinoma, BAL was positive for malignant cell in 13 patients (62%). The diagnostic yield of the BAL was influenced by size, location, radiographic pattern and cell type of the tumour. PBS cytology was positive in 3 patients (14%) only, all of which were positive with BAL fluid also. BAL fluid cytology proved to be a valuable diagnostic tool in diagnosis of endoscopically non-visible lung cancer. Size, location, radiographic pattern and cytological type of the lesions were important determinants of the diagnostic yield. PBS cytology provided no additional benefit.     

微导管在支气管动脉栓塞术中的临床应用

目的：评价微导管在支气管动脉灌注栓塞治疗中晚期肺癌及大咯血的临床应用价值。方法：用微导管超选择性支气管动脉灌注栓塞治疗中晚期肺癌52例及肺大咯血20例。结果：全部病例超选择性插管成功，成功率100％，治疗后肺癌组完全缓解(CR)8例；部份缓解(PR)32例；稳定(S)12例；进展(P)0例；术后1，2，3a生存率分别为100％，75％，40％。咯血组BAE术后即期止血16例，显效4例，无效0例，总有效率100％；全部病例均未出现并发症。结论：在支气管动脉栓塞术中应用微导管安全，可避免并发症的发生。     

Chemotherapy for bronchogenic carcinoma. Methotrexate, doxorubicin, cyclophosphamide, and lomustine

A combination chemotherapy (MACC) consisting of methotrexate, doxorubicin hydrochloride (Adriamycin), cyclophosphamide, and lomustine (CCNU) was given to 41 patients with stage III bronchogenic carcinoma, 34 of whom had disseminated disease. The objective response rate was 46% for all patients with a median actuarial survival of nine months. Response was seen in all cell types, including four of ten patients with squamous cell carcinoma, six of 17 with adenocarcinoma, and six of seven with small-cell anaplastic carcinoma. Prolongation of survival was apparent for patients of all cell types. Toxic reactions were moderate and allowed for easy outpatient use.     

Surgical Treatment of Recurrent Hepatocellular Carcinoma (A report of 112 cases)

GreatprogresshastakenplaceinthetreatmentofHCC.Hepaticresection,asamaintreatment,makespatientssurvivalmarkedlyimproved,butpostoperationrecurrenceisstillaproblemtobesolved.Inourdepartment,among112patientswithrecurrenthepatocellularcarcinomatreatedsurgically,58patientshadsecondaryhepaticresection.Theaimofthisstudywastoevaluatethelong-termresultsoftreatmentandprognositicfactorsinpatientswithrecurrenthepatocellularcarcinomaaftercurativeresectionofhepatocellularcarcinomaandtoclarifytheoptimaltreatm…     

Mediastinoscopy as a predictor of resectability in patients with bronchogenic carcinoma

Eighty consecutive mediastinoscopies, performed for assessment of patients with bronchogenic carcinoma, were reviewed with regard to accuracy and complications. Thirty patients had mediastinal lymph node metastases: 26 were considered inoperable and thus saved non-therapeutic thoracotomy, 4 were considered operable of whom 3 had a curative resection, and one was inoperable at thoracotomy. Of 50 patients with negative mediastinal nodes 43 had thoracotomy; 42 were resectable and one was unresectable. Seven did not have thoracotomy because of other contraindications. In total of 47 patients undergoing thoracotomy on the basis of mediastinoscopy, 45 were resectable, giving mediastinoscopy a positive predictive value for resectability of 95.7%. There was no mortality and two superficial wound infections occurred giving a morbidity of 2.5%. Mediastinoscopy is a safe, reliable and accurate predictor of resectability in patients with bronchogenic carcinoma and continues to have a major role in the management of these patients.     

Management of primary small cell carcinoma of the esophagus

Background Primary small cell carcinoma of the esophagus is rare. Although surgery is successful in eradicating local tumor, the five-year survival rate of patients with primary small cell carcinoma of the esophagus after resection is lower than that of patients with primary squamous cell carcinoma of the esophagus. The purpose of this study was to analyze the clinical manifestations, pathological features and treatment of primary small cell carcinoma of the esophagus. Methods A total of 73 patients with primary small cell carcinoma of the esophagus who had been treated by surgery from 1984 to 2003 were analyzed retrospectively. Results In this series, the overall resection rate was 94.5% （69/73）, the radical resection rate 89.0% （65/73） and the operative mortality 1.4% （1/73）. The 1-, 3- and 5-year survival rates of patients were 50.7%, 13.7% and 8.2%, respectively. Conclusions Primary small cell carcinoma of the esophagus is rare with a poor prognosis. Surgical resection is the leading method for patients with stage Ⅰ or Ⅱ primary small cell carcinoma of the esophagus. Postoperative chemotherapy is beneficial to these patients. The patients of stage Ⅲ or IV should be given chemotherapy and radiation therapy.