支气管袖式肺叶切除肺动脉成形术治疗中心型肺癌

目的 总结支气管袖式肺叶切除、肺动脉成形术治疗中心型肺癌的临床经验.方法 回顾分析1989年5月至2009年5月收治的52例中心型肺癌患者,其中38例行支气管环状切除成形及支气管袖式肺叶切除术;12例行支气管肺动脉双袖式肺叶切除术;2例行气管隆突及半隆突切除重建合并肺叶切除术.结果 本组术后死亡1例,发生手术并发症5例...     

肺动脉切除重建术在肺癌外科治疗中的应用

目的 总结肺动脉切除重建术在肺癌外科治疗中应用的经验。方法 对36例中心型肺癌侵犯肺动脉的病人行肺动脉切除重建术。重建术采用自体心包移植补片5例、奇静脉移植补片3例、心包管间位移植2例,肺动脉袖式切除9例,侧壁切除17例;同时支气管袖式切除30例,肺叶切除6例。术后辅助放疗14例,化疗12例。结果 术后1例支气管吻合口瘘者死亡,余者肺通气及灌注良好。术后1、3和5年生存率分别为82．9％、48．1％和35．3％。结论 应用自体心包、奇静脉移植及直接肺动脉重建术治疗中心型肺癌是一种安全、有效、可靠的术式,能扩大手术适应证,彻底切除肿瘤,保存肺功能,疗效满意。     

支气管袖状肺叶切除肺动脉成形术治疗中央型肺癌

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。方法 1989年5月至2009年5月,对52例中央型肺癌病人施行以支气管袖状肺叶切除术,部分病人同时行肺动脉成形术。包括支气管环状切除成形及支气管袖状成形肺叶切除术38例;支气管肺动脉双袖状成形肺叶切除术12例;气管隆突及半隆突切除重建合并肺叶切除术2例。结果本组手术死亡1例。发生手术并发症5例次,发生率为9.62%;术后1,3,5和10年存活率分别为52.27%,34.09%,18.18%,4.55%。结论以支气管袖状成形肺叶切除术为核心的多种切除重建术式能最大限度保护病人肺功能,提高了中央型肺癌的治愈率和远期存活率。     

肺叶切除并肺动脉重建术治疗中心型肺癌42例体会

目的总结应用肺叶切除并肺动脉重建术治疗中心型肺癌的经验。方法回顾性分析自1995年9月至2006年8月,我院采用肺叶切除肺动脉重建术治疗中心型肺癌42例,其中24例肺动脉楔形切除后10例直接对拢缝合,14例用自体心包片修补;18例行肺动脉段袖式切除后6例直接吻合,5例用自体奇静脉移植,7例用自体心包片作成人工管道间置,恢复血管的连续性;同期有19例施行支气管成形术;术后有29例接受化疗,8例接受放疗。结果术后无死亡病例,并发肺炎7例,轻度肺不张4例,支气管残端漏1例,经治疗后均获痊愈。余者恢复良好,均顺利出院。结论肺叶切除肺动脉重建术治疗中心型肺癌能提高肺癌切除率,扩大手术适应证,最大限度保存患者的肺功能,是一种安全有效的手术方法。     

气管隆突主支气管袖式切除治疗中心型肺癌的临床应用研究

目的:总结32例气管隆突、主支气管切除成形手术治疗中心型肺癌妁经验。方法:主支气管袖状切除对端吻合术16例,全隆凸切除重建1例,左全肺切除部分隆突切除重建1例,右上肺叶切除部分隆空切除重建6例、主支气管楔形袖式切除8例。结果:术后21天死亡1例,系吻合口肉芽肿形成,激光治疗后死于肺动脉破裂出血。术后一年生存率89.28％(25/28),三年生存率60.71％(17/28),五年生存率39.28％(1/28)。结论:气管隆突主支气管切除成形手术提高了中心型肺癌的手术切除率,并取得满意的治疗效果。     

血管重建术在肺癌治疗中的应用

１９９０年４月至１９９６年７月我们对１８例肺癌侵犯血管的病人做肺叶切除、袖状肺叶切除的同时对被侵血管施行了切除成形术或同种血管间位移植术，现报告如下。临床资料　本组中男１３例，女５例；年龄３７～７０岁，平均６１岁。右侧肺癌４例，侵犯上腔静脉侧壁行右肺上叶切除和上腔静脉部分切除２例，右肺中上叶和右肺动脉侧壁切除各１例，右肺动脉右肺上叶联合袖状切除１例；左侧肺癌１４例，行左肺动脉侧壁左肺上叶袖状切除４例，左肺动脉左肺上叶联合袖状切除７例，余３例被侵血管采用同种血管间位移植术。术后病理：腺癌２例，鳞癌…     

进展期右上叶肺癌的外科治疗

１９７９－１９９２年采用不同术式的气管支气管成形术治疗进展期左上叶肺癌１９例。统计资料显示本组病人术后１、３、５、１０年生存率分别 ８２．２％、４０％、３３．３％，高于本院同期原发性肺癌术后生存率。可见采不同术式气管支气管成形术治疗进展克勤克俭期左上叶肺癌有其临床实用性，值得推广。文中还探讨了手术适应证、手术及麻醉经验。并发防治等。     

支气管隆凸血管成形术治疗肺癌96例疗效分析

为探讨支气管、隆凸和血管成形术治疗肺癌的疗效，对９６例中心型肺癌分别施行支气管、隆凸和血管成形术６４、２０和３０例次。随访１、３、５年生存率分别为７９％、５１％、４８％；接受支气管、隆凸、血管成形术的５年生存率分别为５７％、２０％、３１％。结论：支气管、隆凸、血管成形术可以扩大肺癌的手术适应证、最大限度地保存肺功能，疗效不亚于单纯肺切除术。     

全胸腔镜下支气管/肺动脉切除成形肺叶切除术治疗中央型肺癌

目的探讨全胸腔镜下支气管/肺动脉切除成形肺叶切除术的可行性及探索性适应证。方法 2016年4~6月对11例中央型肺癌行全胸腔镜下支气管/肺动脉切除成形肺叶切除及系统性淋巴结清扫术,其中3例行右肺上叶支气管袖式切除成形术,7例行右肺上叶支气管楔形切除成形术,1例行左肺上叶支气管楔形切除成形及左肺动脉干侧壁成形肺叶切除。均采用三孔法全胸腔镜下解剖性肺叶切除。支气管成形采用连续缝合法,经主操作孔吻合成形,肺动脉成形采用近远端阻断后,经主操作孔侧壁成形后加固。结果 11例均顺利完成肺叶切除,其中10例支气管切除成形重建,1例同时行肺动脉干成形,均行系统性淋巴结清扫。右肺上叶支气管楔形切除成形手术时间(切皮至缝皮,下同)210~300 min(中位时间240min),右肺上叶支气管袖式切除成形手术时间210~300 min(中位时间270 min),左肺上叶支气管楔形切除成形+肺动脉干侧壁切除成形手术时间260 min。支气管楔形切除吻合时间11~30 min,中位时间15 min;支气管袖式切除吻合时间25~74min,中位时间30 min;肺动脉侧壁成形15 min。术后无吻合口漏、出血、肺不张、肺部感染、刺激性咳嗽、咯血等并发症,无围手术期死亡。术后平均住院5.1 d(4~7 d)。术后病理:鳞癌9例,腺癌1例,神经内分泌癌1例。11例随访2~4个月,未见肿瘤复发转移征象。结论全胸腔镜支气管/肺动脉成形肺叶切除术治疗中央型肺癌安全可行,其探索性适应证为叶、段支气管开口且无明显肺门淋巴结钙化的中央型肺癌。     

支气管加肺血管、上腔静脉联合成形治疗肺癌

目的探讨支气管袖式或楔形切除加肺血管、上腔静脉成形术在肺癌治疗中的应用及效果。方法全组106例肺癌患者,行支气管袖式切除38例,楔形切除59例;支气管肺血管成形99例,支气管上腔静脉成形7例。结果术后发生并发症11例,其中出血1例,支气管胸膜漏1例,肺不张2例,心衰4例,肺部感染3例,无同术期死亡。1、3、5年生存率分别为76．0％、54．0％、32．4％。结论支气管成形加肺血管、上腔静脉成形对扩大肺癌手术指征,缩小切除范围,提高生存质量有重要意义。     

Bronchoplasty and pulmonary arterioplasty with lobectomy in the treatment of central type lung carcinoma]

From 1982 to 1989, bronchoplasty or segmental bronchoplasty and pulmonary arterioplasty in combination with lobectomy and segmentectomy were performed for 9 patients with central type lung carcinoma. Lobectomy with sleeve excision of the bronchus and the pulmonary artery was done in 3 patients, of which one had bilobectomy plus one segmentectomy with segmental bronchoplasty, lobectomy with wedge excision of the bronchus and the pulmonary artery in 2, lobectomy with wedge excision of the bronchus and sleeve excision of the pulmonary artery in 2, lobectomy with sleeve excision of the bronchus and wedge excision of the pulmonary artery in 1, and regular lobectomy with sleeve excision of the pulmonary artery in 1. Histological examination showed that 5 patients had squamous cell carcinoma, 2 adenocarcinoma, 1 small cell carcinoma, and 1 alveolar cell carcinoma. The postoperative course was uneventful. Follow-up showed that 1 patient lived for more than 5 years, 2 more than 2 years, 1 more than 1 year, and 5 less than 1 year.     

Bronchoplastic procedures for lung cancer

Bronchoplastic procedures for patients with lung cancer are designed to achieve radical cure with preservation of functioning lung parenchyma. The operative results of 139 cases of lung cancer who underwent bronchoplasty between 1963 through 2007 were reviewed. The mean age of the patients was 62.5 years (range, 20 to 78 years). Sleeve lobectomy (SL) was performed in 119 cases, wedge lobectomy (WL) in 10 cases, sleeve segmentectomy (SS) in 5 cases, wedge segmentectomy (WS) in 2 cases, sleeve resection (SR) in 2 cases, and wedge resection (WR) in 1 case. Squamous cell carcinoma was the most frequently encountered histological type of disease (78%), followed by adenocarcinoma (12%) and other histological types (10%). The tumor was central in 125 patients (90%) and peripheral with nodal involvement in 14 patients (10%). Vascular resection and reconstruction was performed in 16 patients. Early major bronchial anastomotic complications occurred in 6 patients (4.3%). The 5-year survival rate in the patients with squamous cell carcinoma was 63.2%, and in patients with adenocarcinoma was 26.3%. SS for patients with early-stage squamous cell carcinoma of the segmental bronchus is a curative operation with preservation of the pulmonary function. Bronchoplasty without lung resection (SR, WR) is a reliable method for patients with low-grade malignant polypoid tumors arising from the bronchus. Patients with adenocarcinoma, N2 disease or major bronchial anastomotic complication show a worse prognosis.     

Successful lung autotransplantation for central non-small-cell lung cancer: report of a case

Non-small-cell lung cancer (NSCLC) confined to the lung is generally treated by surgical resection. The extent of resection is determined by the location of the tumor and the patient’s pulmonary function. This report presents a successful lung autotransplantation in a man with NSCLC that could not tolerate pneumonectomy or sleeve lobectomy. Right upper and middle bilobectomies were performed, the right lower lobe was resected and retrograde perfusion of Raffinose low-potassium dextran solution (4 °C) was administered. The isolated lower lobe was reimplanted by anastomosis of the bronchus, pulmonary artery, and vein. The patient was cancer-free 1 year after the surgery. Lung autotransplantation can therefore be successfully performed for selected patients with central NSCLC.     

Bronchoplastic procedures and pulmonary artery reconstruction in the treatment of bronchogenic cancer

Nineteen patients with primary bronchogenic carcinoma underwent bronchoplastic procedures (six wedge and 13 sleeve resections) between 1970 and 1982. In six of them lobectomy was combined with sleeve resection and reconstruction of the pulmonary artery: In one a synthetic prosthesis was inserted. Twelve patients had squamous cell carcinoma, five adenocarcinoma, and two large cell carcinoma. No operative deaths were observed, and the 5 year survival rate is 28.1%. One patient had an early bronchial fistula and two patients had bronchial stenosis (one suture granulation and one local recurrence). No patient with resection of the pulmonary artery had vascular complications. Survival rates on the basis of nodal involvement indicate 50% survival at 5 years without nodal metastasis (11 cases) versus 9.7% with nodal involvement (eight cases) (p less than 0.05). Bronchoplastic procedures, even if accompanied by segmental resection of the pulmonary artery, can be performed safely with long-term results comparable to those following major pulmonary resections.     

自体心包奇静脉补片肺动脉重建术在中心型肺癌治疗中的应用

目的 探讨自体心包、奇静脉移植补片肺动脉重建技术在中心型非小细胞肺癌治疗中应用的临床价值及其外科技术问题.方法 1992年3月至2009年8月,应用自体心包、奇静脉移植补片肺动脉重建技术治疗62例肺血管受侵犯的中心型非小细胞肺癌.术前行新辅助化疗2个疗程17例,术后pTNM分期:Ⅱb期4例,Ⅲa期46例,Ⅲb期12例.根据肺动脉和支气管受侵的情况,采用自体奇静脉移植补片术18例、心包移植补片术38例、制成心包管间位移植术6例,合并上腔静脉侧壁切除心包奇静脉补片成形术5例,同时行支气管袖式切除51例,肺叶切除11例.术后接受辅助化疗47例,辅助放疗19例.结果 全组术中冰冻和术后病理检查证实肺动脉及支气管切缘均无癌残留.手术死亡2例(3.2%),死因为术后支气管吻合口瘘致呼吸衰竭和术后严重心律失常、心脏骤停各1例.术后主要并发症发生率17.7%(11/62例),经对症处理后治愈.出院前或术后2～6个月经胸部X线、CT、心脏超声及气管镜检查显示2例发生支气管吻合口狭窄,经气管镜微波治疗好转,其余肺通气及血流灌注良好,无肺血管狭窄和栓塞等并发症.60例术后随访6～210个月,平均49.5个月.术后1、3、5、10年生存率分别80.2%(49/60例)、44.7%(21/47例)、31.4%(11/35例)、23.1%(3/13例).结论 自体心包、奇静脉移植补片肺动脉重建技术,可安全、有效地用于治疗肺动脉侧壁切除后缺损较大的中心型肺癌病人;制成心包管间位移植对袖式切除后肺动脉缺损过长吻合困难或失败者,是可行的肺动脉重建技术.

Abstract：

Objective To review the clinical experience of reconstruction of pulmonary artery(PA) by a pateh of autologus pericardium or azygous venae for non-small cell lung cancer. Methods Between March 1992 and August 2009, 62 patients with locally advanced central lung cancer received sleeve resection and reconstruction of PA. According to PTNM classification, 4 patients were in stage Ⅱb, 46 in stage Ⅲa and 12 in stage Ⅲb. 17 patients had induction chemothoerapy. Sleeve lotrate the PA, the surgical procedures included partial PA tangential resections and reconstructions by a pateh of autologous azygous venas in 18 cases , a patch of autologous pericardium in 38 cases and a complete PA sleeve resection reconstructios by a custom-made autologous pericardial conduit interposition in 6 cases. Partial superior vena cava tangential resctions and reconstructions were performed in 5 patients by a patch of autologous pericardium or azygous venae. 47 patients received pstoperative chemotherapy and 19 had radiotherapy. Results There was 2 early postoperative deaths(3.2%). The cause of death was bronchial anastomotic leak led to respiratory failure in 1 case and severe arrhmia led to heart arrest in 1. No cancerous tissue of all resection margins are checked by frzen section histology and examination of resection specimens in the surgical pathology laboratory. The postoperative complications occurred in 11 patients(17.7%) and all of them recovered uneventfully.Roentgenography, flexible bronchoscopy and echocardiography were in normal range in the remaining 60 patients with no bronchial anastomosis stenosis or vascular thombosis before discharge and at 2-6 months after surgery. The mean follow up time was 49.5 months (6-210 months). The overall 1, 3, 5 and 10 yerr survival rates were 80.2%, 44.7% ,31.4% and 23. 1%, respectively. Conclusion Reonstruction of PA by autologous pericardial patch or autologous azygos vein patch is a safe and effective technique for locally advanced lung cancer.For extended circumferential defects of PA,the autologous pericardial conduit interposition could bue used for reconstruction.     

胸腔镜辅助小切口肺血管-支气管成形术治疗中央型肺癌139例分析

目的探讨胸腔镜辅助小切口和常规后外侧切口在肺血管-支气管成形术治疗中央型肺癌中的可行性及效果。方法对广州医学院第一附属医院1995年1月至2007年7月139例采用胸腔镜辅助小切口术式及四川大学华西医院2000年4月至2005年12月99例采用常规后外侧切口术式的因病变涉及肺叶开口或肺动脉,而行肺血管-支气管成形术患者的临床资料进行回顾性分析。结果两组患者均顺利完成手术,无围手术期死亡,术后无吻合口狭窄、吻合口瘘及切缘癌细胞残留。胸腔镜辅助小切口组平均生存时间为63．17个月,常规后外侧切口组为42．00个月,术后生存率无明显差异。肺动脉成形患者的保留肺叶无肺再灌注损伤或明显肺水肿征象。胸腔镜辅助小切口组辅助切口的平均长度为10cm,常规后外侧切口组切口平均长度为30cm。胸腔镜辅助小切口组手术时间、术后胸管留置时间及住院时间均短于常规后外侧切口组,术后患侧肩关节功能障碍发生率低。结论利用胸腔镜辅助小切口施行肺血管一支气管成形术,不仅具有与常规后外侧切口相同的适应证和术后生存率,而且在减小手术创伤,促进患者恢复方面具有优势。     

应用自体肺移植技术治疗上中中心型肺癌

目的 探讨应用自体肺移植技术治疗上叶中中的可行性。方法 ２例作双袖状右上中叶联合肺叶切除,因支气管切除过和戒肺动脉切除过长,吻合张力过大,做下肺静脉切断,肺短时间离体后作下叶重植,将下肺静脉移下于上肺静残端。２例右上叶肺主斜裂,无法进行双袖状肺叶切除术,行全肺切除后,在器械台上行肿瘤切除,下叶修剪后重植于胸腔内。结果 随访至１９９９年１２月,第１、３、４例患者已分别无瘤存活３１、１８和１３个月。第