支气管、隆凸及肺血管成形术治疗中央型肺癌92例临床分析

背景与目的 外科手术是早、中期非小细胞肺癌的首选治疗方案.本文总结支气管袖状、隆凸切除及支气管肺动脉双袖状成形术等手术方式治疗92例中央型肺癌的临床经验.方法 对我院1996年1月-2010年5月间92例中央型肺癌患者施行以支气管袖状成形术为主的多种切除重建手术.其中右肺上叶支气管袖状切除术49例,左肺上叶袖状切除术14例,右肺中叶袖状切除术3例,左肺下叶袖状切除术4例,左肺支气管肺动脉双袖状成形肺叶切除术8例,右肺上叶切除合并器官隆凸切除重建3例,全肺切除合并气管隆凸切除重建术7例,主气管袖状切除4例.结果 无围手术期死亡病例,平均手术时间2 h 43min,平均失血415 mL,术后肺不张7例(7/92),声音嘶哑4例(4/92),机械通气支持3例(3/92).1年、3年、5年生存率分别为80.7%、59.6%、31.5%.结论 隆凸切除、支气管袖状成形术、支气管肺动脉双袖状成形术等术式既能最大限度地切除肿瘤,又能最大限度保护了肺功能,且隆凸切除气道重建术能进一步扩大手术适应症,提高了中央型肺癌的手术切除率.     

同时支气管肺动脉联合成形术治疗中央型肺癌

背景与目的：近年来支气管肺动脉联合成形术愈来愈广泛的应用于肺功能不佳的肺癌患者中，该术式符合最大限度地切除肺癌和最大限度地保留肺功能的肺癌手术原则，该项手术技术有着很好的前景。我们总结近年来采用支气管肺动脉联合成形术治疗中央型肺癌的体会来探讨该项手术的应用指征和方法。方法：1993年12月-2003年12月，对63例中央型肺癌施行支气管肺动脉联合成形肺叶切除，包括支气管肺动脉双袖状切除术43例，其中右肺上叶袖切＋肺动脉袖切20例；左肺上叶袖切＋肺动脉袖切23例；切除肺动脉的长度为1．5～4．5cm，平均2．5cm．支气管肺动脉双禊形切除术3例；其中右肺上叶禊切＋肺动脉楔切2例；左肺上叶楔切＋肺动脉楔切1例。支气管袖切并肺动脉禊切17例，其中右肺上叶袖切＋肺动脉楔切5例；左肺上叶袖切＋肺动脉禊切12例。结果：本组无死亡及吻合门瘘发生：结论：支气管肺动脉联合成形术使肺癌手术指征扩大，符合最大限度地切除肿瘤及最大限度保留肺功能的肺癌手术基本原则，是一种安全、有效、可行的术式。     

支气管肺动脉袖状成形术治疗侵犯肺动脉干的Ⅲ期肺癌

目的 总结304例支气管肺动脉袖状成形肺叶切除术或合并其它心脏大血管切除重建术治疗侵犯肺动脉干的局部晚期肺癌的临床疗效。方法 1983年2月至2001年12月，对304例肺癌患者施行支气管肺动脉袖状成形肺叶切除或合并其它心脏大血管切除重建术。支气管肺动脉袖状成形左上叶切除术199例；支气管肺动脉袖状成形右肺上叶切除术21例；支气管肺动脉袖状成形右肺中上叶切除术14例；支气管肺动脉袖状成形左上叶切除合并部分左心房切除8例；支气管肺动脉袖状成形右肺上叶切除合并上腔静脉切除人造血管重建术29例；支气管肺动脉袖状成形右肺中上叶切除合并上腔静脉切除人造血管重建术21例；支气管肺动脉袖状成形右肺中上叶切除、气管隆凸切除重建，合并上腔静脉切除人造血管重建术11例；右肺动脉干部分切除、肺动脉圆锥大部切除，人造血管右肺动脉干、肺动脉圆锥重建合并左全肺切除术。结果 本组手术死亡3例，死亡率为1％。发生手术并发症64例次，发生率为21.05%。术后1、3、5和10年生存率分别为81.75%、60.14%、37.21%和24.39%。结论 支气管肺动脉袖状成形肺叶切除或／和合并其它心脏大血管切除重建术均能明显改善局部晚期肺癌的预后，提高治愈率和生存率。     

袖状肺叶切除肺动脉成形术治疗中央型肺癌11例

目的：总结支气管袖状肺叶切除、肺动脉成形术治疗中央型肺癌的经验体会。方法：1998年1月至2006年12月,对11例中央型肺癌患者分别施行袖状肺叶切除,部分患者同时行肺动脉成形术,包括左肺上叶支气管袖状切除1例;右肺上叶支气管袖状切除4例;右肺上中叶支气管袖状切除1例;右肺上叶支气管袖状及右肺动脉成形4例;右肺上叶支气管及右肺动脉双袖状切除1例。疗效满意,回顾分析其临床资料。结果：全组患者无住院死亡（〈30天）。发生手术后并发症3例,发生率27.3%。2例分别于术后1年、3年死亡,余健在。结论：部分中央型肺癌进行袖状肺叶切除、肺动脉成形术是安全、有效、可行的,能最大限度切除病灶和保留健肺,提高了中央型肺癌患者的治愈率和远期生存率。     

87例中心型肺癌支气管肺动脉成形术的疗效观察

目的 总结87例支气管、肺动脉成形术治疗中心型肺癌的疗效.方法 1999年2月-2006年2月对87例中心型肺癌施行支气管、肺动脉成形术,其中隆凸切除、气道重建术8例,肺叶支气管袖状切除术15例,肺叶支气管袖状切除加肺动脉侧壁切除术12例,肺叶切除加肺动脉侧壁切除术24例,肺叶支气管楔形切除术28例.结果 全组死亡1例,并发症发生率为12.6%(11/87),术后1、3、5年生存率分别为82.8%(72/87)、49.4%(43/87) 40.2%(35/87).结论 支气管、肺动脉成形术治疗中心型肺癌,可最大限度地切除病灶,最大限度地保留健康组织,改善患者生活质量,提高生存率.     

隆凸、支气管及肺动脉切除重建术治疗中心型肺癌

背景与目的 为了最大限度地保留健康肺组织，提高中心型肺癌患者的手术切除率和术后生活质量，气管隆凸、支气管及肺动脉成形术在国内外得到了广泛的应用。并取得了良好的治疗效果。本研究的目的是总结采用隆凸、支气管及肺动脉切除重建术治疗79例中心型肺癌的临床资料，分析其疗效。方法1988年6月至2005年6月，对79例中心型肺癌患者施行隆凸、支气管及肺动脉切除重建术。支气管环状切除成形及支气管袖状成形肺叶切除术58例；支气管肺动脉双袖状成形肺叶切除术15例；气管隆凸切除重建合并肺叶切除术6例。结果 本组无手术死亡病例。7例患者术后出现并发症，发生率为8．86％。术后1、3、5和10年生存率分别为78．5％、59．5％、35．4％和17．7％。结论 隆凸、支气管及肺动脉切除重建术能最大限度地保护肺功能，提高了中心型肺癌的治愈率和远期生存率。     

隆凸合并心脏大血管切除重建术治疗局部晚期中心型支气管肺癌

背景与目的 迄今，同时侵犯隆凸和心脏大血管的局部晚期非小细胞肺癌仍被视为外科手术治疗的禁忌证。本研究的目的是总结我院施行隆凸合并心脏大血管切除重建术治疗84例侵犯隆凸和心脏大血管的局部晚期非小细胞肺癌的临床经验。方法 1988年3月～2004年12月，对84例同时侵犯隆凸和心脏大血管的局部晚期中心型非小细胞肺癌施行隆凸合并心脏大血管切除重建术。本组隆凸、心脏大血管切除重建术式包括：（1）隆凸切除重建合并右肺动脉袖状切除重建袖式右肺上叶切除术（气管-左主支气管-右中间支气管重建）9例；（2）袖式右全肺切除合并上腔静脉切除人造血管重建加部分左心房切除重建术3例；（3）隆凸切除合并左肺动脉袖状切除重建袖式左上叶切除加部分左心房切除重建术3例；（4）隆凸切除合并部分左心房切除重建和右肺动脉袖状切除重建袖式右上叶切除术（左主支气管-气管端端吻合，右中间支气管-气管端侧吻合）10例；（5）隆凸切除合并左肺动脉袖状切除成形左上叶切除术9例；（6）隆凸切除合并左肺动脉袖状切除成形左上叶切除＋主动脉弓鞘膜切除6例；（7）隆凸切除合并右肺动脉袖状切除成形右中上叶切除术3例；（8）隆凸切除合并左肺动脉袖状切除成形左上叶切除、主动脉弓鞘膜切除＋部分左心房切除重建术8例；（9）隆凸切除合并右肺动脉袖状切除成形右上叶切除加部分左心房切除重建术4例；（10）袖式左全肺切除（气管-右主支气管端端吻合）合并部分左心房切除重建术3例；（11）隆凸切除合并右肺动脉袖状切除成形右中上叶切除加上腔静脉切除人造血管重建术23例；（12）袖式右全肺切除（左主支气管-气管端端吻合）合并部分左心房切除术1例；（13）隆凸切除合并右肺动脉袖状切除成形右中上叶切除加部分左心房切除重建术1例；（14）隆凸切除合并右肺动脉袖状成形右中上叶切除加右肺下静脉袖状切除和右肺下静脉-左心房端侧吻合术1例。结果 本组手术死亡2例，死亡率为2．38％。发生手术并发症32例次，发生率为38．10％。术后1、3、5和10年生存率分别为81．34％、59．47％、31．73％和24．06％。结论 （1）施行隆凸合并心脏大血管切除重建术在技术上是可行的；（2）隆凸切除合并心脏大血管切除重建术为主的多学科综合治疗能明显提高局部晚期非小细胞肺癌患者的生存率，改善患者预后和生活质量。     

气管隆凸、支气管、肺动脉成形术治疗肺癌

背景与目的　气管隆凸、支气管、肺动脉成形术在国内外应用广泛,这种手术扩大了肺癌手术适 应证,保留更多的健康肺组织,使一部分心肺功能差的中心型肺癌患者可获得比全肺切除术更好的治疗效果。 本研究旨在探讨中心型肺癌进行选择性扩大切除手术的可行性和手术适应证。方法　1979年11月至2003 年1月对50例中心型肺癌施行肺叶或全肺切除术,同时行气管隆凸、支气管或肺动脉成形手术。本组气管隆 凸、支气管成形术48例,肺动脉成形术2例。结果　本组发生手术并发症4例(8.0%),死亡2例(4.0%)。 本组病例均进行长期随访,术后1、3、5、10年生存率分别为89.4%(42/47)、57.1%(20/35)、42.1%(8/19)和 25.0%(2/8)。结论　部分中心型肺癌选择性进行肺叶或全肺切除的同时进行气管隆凸、支气管或肺血管成 形术是可行的,这种手术能最大限度地清除病灶和保留健肺,有利于延长生存期。     

支气管成形肺切除术治疗肺肿瘤的体会

我院自1992年来行支气管成形肺切除术治疗支气管肺肿瘤7例,取得了较好效果,报道如下。1　临床资料1.1.一般资料　本组男5例,女2例。年龄38～72岁,平均51岁。良性肿瘤2例;中心型肺癌3例,周围型2例。ＴＮＭ分期:Ⅱ期3例,Ⅲａ期2例。左肺5例,右肺2例。1.2.治疗方法及结果　左全肺切除加隆凸楔形切除术1例,袖状左肺下叶切除2例,左肺下叶切除加二级隆凸楔形切除1例,袖状左肺上叶切除1例;右中下肺叶切除加支气管及上肺静脉成形术1例,袖状右肺下叶切除1例。全部治愈。2　讨论2.1　术前准备　肺切除术的常规准备;气管插管全麻置双腔管,无条件时插单…     

肺动脉成形术治疗中心型肺癌

肺动脉成形术治疗中心型肺癌昂春臣赵宏山东省滕州市中心人民医院（滕州２７７５００）我们采用肺动脉成形肺叶切除术治疗中心型肺癌１１例，其中肺动脉袖状切除６例、肺动脉侧壁切除２例、肺动脉楔状切除３例。同时行肺动脉支气管联合成形５例：左肺动脉楔状切除及支气管...     

Forehead reconstruction

Guidelines for forehead reconstruction include maintaining or re-establishing normal boundaries, preserving nerve function, and maximizing scar camouflage. The interrelationships of anatomy, function, and principles of tissue movement which are critical to optimal reconstructive planning will be presented.     

Periorbital reconstruction

Reconstructions of the lower lid, the upper lid, the medial canthus, the infraorbital area, and the eyebrow area are reviewed. Various flap procedures are described.     

Scalp reconstruction

Scalp reconstruction after oncologic resection can be challenging. Wide surgical resections, in combination with co-morbid conditions such as infected alloplastic material, cerebrospinal fluid (CSF) leak, or devascularized bone after craniotomy necessitate healthy, vascularized tissues for reconstruction. Although primary closure is feasible in some cases, the mainstay of treatment involves local tissue rearrangement with or without split thickness skin grafting. In addition, free tissue transfer is an important adjunct to therapy in patients with poor local tissues. Careful analysis of the defect and local tissues can help tailor the method of reconstruction and result in satisfactory closure in a majority of patients. Current techniques used for scalp reconstruction after surgical ablation are the subject of this review.     

Laryngopharyngeal reconstruction

There is a high incidence of hypopharyngeal cancer is our country due to the habits of tobacco and alcohol. Moreover these cases are often detected in the late stages thereby making the issue of reconstruction very tedious and unpredictable. There are a number of options for laryngopharyngeal reconstruction available now including the use of microvascular flaps depending upon the patient’s fitness, motivation, technical expertise, size and extent of the defect. This article reviews the different methods of laryngopharyngeal repair as regards their success rate, radiation tolerance, morbidity & mortality.     

Lower extremity reconstruction

The current recommendation for surgical treatment of tumors of the lower extremity is a limb-sparing resection. Limb-sparing resection coupled with complex reconstructive techniques and complemented by new chemotherapeutic agents and adjuvant radiation therapy has allowed us to achieve survival rates that are comparable to those of amputation with a better functional outcome. Recent advances in microsurgical techniques and the associated technologies and a better understanding of microvascular anatomy has allowed us to customize flaps to the specific needs of the patients and to achieve a lower donor site morbidity. Increased communication between the specialties of the multidisciplinary treatment team has also improved outcomes. The reconstructive component has become an integral part of the multidisciplinary care for patients with lower extremity tumors. It not only allows them to rapidly resume adjuvant therapies but also enables them to more easily resume their activities of daily living.     

Breast reconstruction today

Present surgical techniques and prostheses now permit any woman who has had a mastectomy to be reconstructed. Whether a woman should have breast reconstruction must be decided only after full discussion of prognosis and attainable goals with the woman herself. A variety of choices of procedure, timing, and extent of surgery are available.     

Nipple areola reconstruction

Nipple areola reconstruction is often considered the "finishing touch" in the process of breast reconstruction after surgery for breast cancer. Attention to detail with respect to patient selection, timing of reconstruction and surgical technique must therefore be paid to avoid an unsatisfactory result that may taint an otherwise successful reconstructive sequence. There are many surgical techniques available to recreate the nipple areola complex, but each of the various techniques is designed to accomplish similar goals. In every case, regardless of the technique chosen, the surgeon seeks to reconstruct a nipple areola complex that is esthetically pleasing in its color, symmetry, position on the breast mound, and projection.     

Immediate postmastectomy reconstruction

The role of reconstruction in the management of patients with problems related to breast cancer is of increasing importance. Immediate reconstruction is particularly applicable in those situations where prophylactic mastectomy is performed. High-risk groups who warrant such prophylactic mastectomy and reconstruction include those with florid cyst disease, a strong family history of breast cancer, the finding of lobular carcinoma in situ, multiple previous biopsies, and those who have severe and progressive mastodynia. In those with smaller amounts of breast tissue, reconstruction is based on a double layer of tissue over a graft, one layer consisting of pectoral muscle and the other of breast skin. In those with more abundant breast tissue, the two layers placed over the graft are both derived from skin flaps, the inner layer a free, denuded dermal graft from the inferior flap and the second layer, the superior breast skin flap itself.     

Lower eyelid reconstruction

The Hughes procedure of tarsoconjunctival flap sharing for lower eyelid reconstruction following removal of basal cell carcinoma is described. Although this technique has the disadvantage of being a 2-staged procedure that requires closure of the eyelid for 2-8 weeks, its cosmetic and functional results are outstanding. While the Hughes procedure is not the only technique for eyelid reconstruction, it is a time-tested method commonly practiced by ophthalmic plastic surgeons.