非小细胞肺癌肺动脉成形、肺叶切除24例分析

对我科1994-10～2005-08行肺动脉成形肺叶切除治疗肺癌24例分析如下。 1．1一般资料 本组男20例，女4例，年龄36～70（平均52）岁。其中鳞癌18例，腺癌6例。左上肺叶肺动脉袖状切除6例，左上支气管及肺动脉双袖状切除3例，左上肺叶肺动脉侧壁切除8例，右上肺及肺动脉侧壁切除5例，右中叶及肺动脉壁切除2例。袖状切除血管最长为3cm。Ⅰ期2例．Ⅱ期10例，Ⅲ期12例。     

支气管袖状切除联合肺动脉成形术在中央型肺癌手术中的应用11例分析

目的：探讨支气管袖状切除联合肺动脉成形术治疗中央型肺癌的临床效果。方法：对2007—01／2009—09齐齐哈尔市第一医院开展的该类手术治疗11例肺癌患者进行分析。结果：本组均取得满意效果。结论：支气管肺叶袖式切除联合肺动脉成形术是治疗中央型肺癌的先进术式,不仅能保留有功能的肺组织,减少呼吸衰竭的并发症,而且提高了切除率,扩大了手术适应证,改善生存质量。     

支气管袖状切除和肺动脉成形术治疗左上叶中央型肺癌临床体会

目的 总结采用以支气管袖状切除和肺动脉成形术治疗左上叶中央型肺癌的经验.方法 对30例左上肺非小细胞中央型肺癌行左上肺叶支气管袖状切除术,其中10例行左上叶支气管和左肺动脉双袖状切除术.结果 无手术死亡病例.发生手术并发症4例次,发生率为10.33%.术后1、3、5、10年生存率分别为77.4%、58.5%、36.4%、18.4%.结论 以肺叶袖状切除和肺动脉成形术治疗左上叶中央型肺癌术式能最大限度地保护肺功能,提高左上叶中央型肺癌的手术切除率,取得满意的治疗效果.     

肺癌530例手术后的监测与护理

目的 探讨肺癌手术后监测内容与护理措施.方法 开胸手术的肺癌患者530例,肺叶切除365例,全肺切除83例,肺叶支气管抽状切除80例,剖胸探查术2例.术后经重症监护186例,呼吸机辅助呼吸169例.辅助时间0.5～3 h.采取多参数监测生命体征,呼吸机辅助呼吸,呼吸道护理,引流管护理.结果 术后经重症监护186例,呼吸机辅助呼吸169例.通过重症监护,不仅预防和降低了手术后的并发症,提高了手术的成功率,缩短了总的住院日,还减少了患者的经济负担.165例病情平稳,回病房,3例肺感染,1例心力衰竭,经积极治疗,病情平稳回病房.结论 加强肺癌手术后监测,积极采取护理措施,降低了术后并发症,使患者康复出院.     

原发性中叶肺癌的诊断与治疗

目的:探讨原发性中叶肺癌的临床诊断和治疗特点。方法:总结10年间手术治疗的65例原发性中叶肺癌的诊治经验。本组UICC分期:Ⅰ期10例、Ⅱ期26例、Ⅲ期29例。行根治性肺叶切除手术54例,其中右肺中叶切除术14例,双肺叶切除15例(含袖式肺叶切除术4例),右肺中叶加受侵邻叶部分切除术8例,全肺叶切除17例。行姑息性肺叶切除11例,结果:右肺中叶肺癌发病率低,易误诊和延误诊断,临床上手术治疗的晚期病例较多。动态的比较胸片、胸部CT检查结果,配合纤维支气管镜检查有助于提高早期诊断率。本组病例 1、3年生存率 81.5％、53.8％。Ⅰ、Ⅱ期病人术后3年生存率69.4％、与Ⅲ期病人术后3年生存率34.5％比较差别有非常显著性意义(P<0.005)。根治手术病例3年生存率61.1％,姑息手术病例3年生存率18.2％,两组比较差异有非常显著性意义(P<0.01)。结论:减少原发性中叶肺癌的误诊和延误诊断,是减少晚期病人的重要因素。手术治疗以肺叶切除术为主。在肺功能允许的条件下对跨叶性病变应选择双肺叶、袖式肺叶切除术或全肺叶切除术,避免做受侵肺叶局部切除术,以减少局部复发。     

气管、支气管成形术治疗中心型肺癌11例体会

近十多年来 ,随着气管、支气管成形、肺叶切除治疗肺癌的普遍开展及疗效的提高 ,使之成为肺癌手术治疗的标准术式之一 ;同时也使得全肺切除的比率已明显下降[1] 。本院自 1987年 7月至 1999年 7月 ,采用这一方法成功地治疗中心型肺癌 11例 ,报道如下。1　临床资料1.1　一般资料　本组 11例 ,男 8例 ,女 3例。平均年龄 5 2 .4 (40～ 6 2 )岁。从发病至入院时间 1～ 8个月 ,多数在 3个月内入院并手术治疗。病变部位全在上肺叶 ;左侧 5例 ,右侧 6例。按ＴＮＭ分期 :Ⅰ期 1例(Ｔ2 Ｎ0 Ｍ0 ) ,Ⅲａ期 9例 (Ｔ3 Ｎ2 Ｍ0 4例、Ｔ2 Ｎ2 Ｍ0 2例、Ｔ3…     

65岁以上老年中心型非小细胞肺癌47例手术分析

目的:回顾性总结65岁以上老年中心型非小细胞肺癌患者47例。方法:术前充分呼吸道准备,术中应用支气管袖状切除,和(或)肺动脉成形、隆突重建合并切除部分心包及大血管组织,治疗中心型肺癌47例,其中左上叶袖状切除17例,右上叶袖状切除重建27例,右上叶袖状合并隆突切除1例,右中叶及下叶背段袖状切除重建2例,同时行肺动脉切除成形11例。术后配合纤维支气管镜吸痰。结果:全组无手术死亡。无院内死亡。结论:对于肺功能较差的老年患者,采用支气管袖状切除和(或)同时肺动脉成形可扩大中心型肺癌的手术指征,符合肺癌手术"两个最大限度"的原则。手术效果好。     

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 回顾性总结支气管肺癌手术治疗93例，其中86例行支气管袖状肺叶切除成形术，7例行支气管及肺动脉袖状切除成形术。结果 随访67例，2年生存率64％，5年生存率34．3％。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，改善患者的生存质量，远期疗效良好。     

全胸腔镜肺叶切除肺动脉成形的初步探讨

电视胸腔镜技术已在胸外科手术多个领域得到发展[1-2],其临床应用在一定程度上改变了肺癌外科治疗的概念,尤其在重新界定肺癌的微创手术适应证和禁忌证方面有了突破,目前较广泛接受的是应用于Ⅰ期周围型肺癌[3].非小细胞肺癌侵犯肺动脉主干或分支血管壁,不能用常规方法处理需要行肺动脉侧壁部分切除成形或肺动脉部分袖式切除成形,常常由于手术难度大、操作复杂而采取常规开胸手术的方法.我们采取完全电视胸腔镜下肺叶切除合并肺动脉成形,拓展了电视胸腔镜下肺癌外科治疗的手术范畴,使更多的肺肿瘤患者获益于微创外科治疗.     

气管隆突重建、支气管成形术治疗中央型肺癌32例

[目的]分析气管隆突重建、支气管成形肺切除术治疗中央型肺癌的近期及远期疗效。[方法]自1995年5月到2006年12月共手术治疗原发性肺癌520例,其中气管隆突切除6例、支气管成形肺叶切除术26例,合计为32例。[结果]术后发生肺不张3例,心律失常1例,无手术死亡,术后1年生存率78.1%（25/32）,3年生存率56.3%（18/32）,5年生存率37.5%（12/32）。[结论]支气管成形术治疗肺癌是一成熟的术式,疗效取决于疾病的分期和正确的适应证选择,术中的根治切除和术后的综合治疗。     

侵犯胸壁的非小细胞肺癌的外科治疗

目的：探讨侵犯胸壁的非小细胞肺癌的手术方法厦其预后因素。方法：回顾性分析1984-2005年我院手术治疗的侵犯胸壁的NSCLC127例。T3N0M072例，T3N1M033例，T3N2M017例，T4N0M03例，T4N1M02例；鳞癌66例，腺癌59例，大细胞癌2例。手术方式：肺单叶切除78例，两叶切除7例，全肺切除33例，楔形切除或段切9例。胸壁整块切除46例，胸壁不连续切除13例，胸膜外切除68例。结果：全组无手术死亡病例。11例术后出现并发症。5年生存率在完全切除及不完全切除的患者分别为25％及8％（P〈0．05）。在完全切除的病例中，淋巴结转移情况（P〈0．05），侵润深度（P〈0．05）具有独立估计预后的价值。结论：侵犯胸壁的NSCLC的生存率与切除是否完全，淋巴结转移情况厦肿瘤侵犯胸壁的深度有关。如果肿瘤看起来是黏在胸壁上，而不是固定在胸壁上，则采取胸膜外切除。如果有任何迹象表明胸壁切除是必要的，就应进行胸壁切除。     

Case of thoracoscopic right upper lobectomy for lung cancer with tracheal bronchus and a pulmonary vein variation

A 58-year-old woman visited our hospital with the chief complaint of an abnormal chest shadow. Chest CT showed an 18-mm ground-glass opacity in the right upper lobe, which became enlarged over time, and lung cancer was suspected. At the same time, a tracheal bronchus originating directly from the trachea was observed. She underwent thoracoscopic right upper lobectomy and mediastinal lymph node dissection. During surgery, in addition to the tracheal bronchus, a pulmonary vein variation was seen running dorsal to the pulmonary artery. Her postoperative course was uneventful. Tracheal bronchus is a rare anomaly, with an incidence of 0.1%-5%. Since tracheal bronchus is often accompanied by pulmonary vessel variations and may be associated with repeated previous infections, care should be taken when performing thoracoscopic lung resection.     

双袖式肺叶切除治疗局部晚期非小细胞肺癌

目的:总结31例肺动脉支气管双袖式肺叶切除手术的临床经验,探讨其手术适应证、手术技巧以及术后处理。方法:1996年1月-2006年12月共完成肺动脉支气管双袖式肺叶切除手术31例,其中男性24例,女性7例;年龄43～75岁,平均62岁;鳞癌24例,腺癌3例,腺鳞癌4例。病变位于左侧30例,右侧1例。行支气管肺动脉袖式左上肺叶切除术26例,支气管袖式、肺动脉部分成形左上肺叶切除术4例,支气管肺动脉袖式右上肺叶切除术1例,通过回顾病史总结临床经验。结果:术后多数患者出现排痰不畅,需行纤维支气管镜吸痰。术后发生各种并发症4例,发生率12.9%(4/31),其中肺炎3例、肺不张1例。术后死亡1例,病死率3%(1/31)。结论:支气管肺动脉双袖式肺叶切除术使某些病程较晚、年龄偏高、心肺功能低下的患者获得手术机会,扩大了肺癌的手术适应证,延长生存期,提高了患者的生活质量,但应严格掌握手术适应证、熟练手术操作及术前术后处理。     

支气管肺动脉成形术治疗中央型支气管肺癌

目的：探讨支气管肺动脉成形术治疗中心型肺癌的效果。方法：1998年12月至2008年12月对16例中央型肺癌施行支气管肺动脉联合成形肺叶切除,包括双袖式左肺上叶切除7例;双袖式右肺上叶切除2例;双袖式右肺中上叶切除2例;双袖式右肺中上叶切除同时隆突重建2例;袖式左上肺叶切除、肺动脉楔形切除2例;袖式右肺中上叶切除、肺动脉楔形切除1例。结果：本组无死亡及吻合口瘘发生,术后2例出现肺不张,2例并发肺感染,全组术后1年生存率为93．8％,3年生存率为62．5％。结论：肺动脉成形或肺动脉支气管同时成形肺叶切除减少了全肺切除和单纯剖胸探查的比例,扩大了手术适应征,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。     

Video-assisted thoracoscopic surgery for the treatment of lung cancer

A growing proportion of lung resections is being performed by video-assisted thoracoscopic surgery (VATS). VATS lobectomy is indicated for clinical stage I suspected lung cancer with pulmonary function sufficient to tolerate resection. Retrospective and matched analyses suggest less morbidity with fewer postoperative complications with VATS compared with open lobectomy. Five-year survival for VATS lobectomy in stage I non-small lung cancer patients approaches 80%. A potential oncologic benefit of VATS lobectomy (over thoracotomy) has been proposed through attenuation of postoperative cytokine release. Regardless of whether VATS or an open approach is utilized, thorough lymphadenectomy is important and may confer an additional survival benefit.     

肺小结节胸腔镜切除术前CT引导下带钩金属导丝锚定

目的 探讨肺小结节胸腔镜切除术前CT引导下带钩金属导丝锚定操作方法及其临床应用价值。方法 对28例恶性肿瘤患者共30枚肺小结节行CT引导下带钩金属导丝锚定辅助胸腔镜切除,评估结节定位的成功率、手术时间、并发症,分析其对患者肿瘤分期及疗效评价的影响。结果 术前CT引导下带钩金属导丝定位平均手术时间为(15.0±3.2)min。28例患者(共30枚)肺小结节中,1例(1枚)患者术中见定位针脱落,行肺叶切除;另27例(29枚)结节均准确定位并行楔形肺切除。定位术后7例(7/28,25.00%)患者发生少量气胸,针道周围少量出血8例(8/27,29.63%),其中3例(3/28,10.71%)患者同时出现少量气胸和针道周围少量出血。术后病理证实15例(15/28,53.57%)肿瘤复发转移,1例(1/28,3.57%)患者为第二原发癌,12例(12/28,42.86%)患者因确诊为肺内良性结节确定肿瘤分期不变或疗效稳定。结论 肺小结节胸腔镜切除术前CT引导下带钩金属导丝锚定操作便捷,成功率高,并发症少,对患者肿瘤准确分期及疗效评价有重要意义。     

Bronchogenic carcinoma treated by concomitant resection of lung and chest wall.

Chest wall invasion by bronchogenic carcinoma is found in 5% of all cases of pulmonary carcinoma. During the last 3 years, 11 cases of lung cancer with chest wall involvement have been encountered at the Jackson Veterans Administration Medical Center. We reviewed these cases to reassess the role of concomitant resection of the lung and chest wall. From this experience, we have concluded that (1) chest wall involvement is potentially curable; (2) chest wall resection adds little if any morbidity to the procedure; (3) resections of fewer than four ribs usually require only soft tissue coverage, without a prosthesis; (4) patients with squamous cell cancer have longer survival; (5) chest wall resection is highly effective in the relief of pain due to invasion of the chest wall; and (6) survival is greater than in other stage III lung carcinomas and is more closely related to nodal involvement than to chest wall invasion.     

98例肺错构瘤的诊断与外科治疗

目的总结肺错构瘤的临床特征和外科治疗经验。方法回顾分析98例肺错构瘤患者的临床特点、影像学特征,从中找出其与肺癌、肺结核瘤的鉴别要点,通过微创外科治疗与常规开胸手术治疗的对比,总结微创外科治疗经验及体会。结果 98例患者中有症状者66例,术前诊断为肺错构瘤18例,肺癌25例,肺结核瘤15例,肺炎性假瘤10例,肺内阴影性质待查30例。误诊率81.6%(80/98)。结论肺错构瘤误诊率很高,确诊靠病理诊断,手术切除是惟一有效的治疗方法,而微创外科治疗较常规开胸手术治疗更具优越性。     

Predictors of respiratory failure after thoracic surgery: a retrospective cohort study with comparison between lobar and sub-lobar resection

ObjectiveOnly approximately 15% of patients with lung cancer are suitable for surgery and clinical postoperative outcomes vary. The aim of this study was to investigate variables associated with post-surgery respiratory failure in this patient cohort.MethodsPatients who underwent surgery for lung cancer were retrospectively studied for respiratory function. All patients had undergone lung resection by a mini-thoracotomy approach. The study population was divided into two subgroups for comparison: lobectomy group, who underwent lobar resection; and sub-lobar resection group.ResultsA total of 85 patients were included, with a prevalence of lung cancer stage IA and adenocarcinoma histotype. Lobectomy (versus sub-lobar resection), the presence of chronic obstructive pulmonary disease (COPD), and a COPD assessment test (CAT) score >10, were all associated with an increased risk of respiratory failure. The partial pressure of arterial oxygen decreased more in the lobectomy group than in the sub-lobar resection group following surgery, with a significant postoperative between-group difference in values. Postoperative CAT scores were also better in the sub-lobar resection group.ConclusionsPost-surgical variations in functional parameters were greater in the group treated by lobectomy. COPD, high CAT score and surgery type were associated with postoperative development of respiratory failure.     

Precise localization of small pulmonary nodules using Pre-VATS with Xper-CT in combination with real-time fluoroscopy-guided coil: report of 15 patients

Purpose: This study aimed to evaluate the value of precise localization of nodules using pre-video-assisted thoracic surgery (VATS) Xper–CT in combination with real-time fluoroscopy-guided coil in the resection of pulmonary nodules using VATS.Materials and Methods: Precise localization of nodules using Xper-CT in combination with real-time fluoroscopy-guided coil and wedge resection using VATS were conducted on 15 patients with 17 small pulmonary nodules (diameter 0.5–1.5 cm) from April 2015 to January 2016. The value of localization was evaluated in terms of procedure time, type of coils, associated complications of localization, and VATS success rate.Results: The success rate of coil localization was found to be 100% in the primary stage (as shown by the CT scan), and the average procedure time was 30–45 min (35.6 ± 3.05 min). No deaths or major complications occurred. Minor complications included five incidents of pneumothorax (the morbidity was 29.4%, 5/17; no patient required chest tube drainage). The dislocation of coil was found in one patient. The results of pathological examination of 17 small pulmonary nodules revealed 11 primary lung cancers, 1 mesenchymal tumor, 3 nonspecific chronic inflammations, 1 hamartoma, and 1 tuberculosis. Two patients with primary lung cancer underwent lobectomy with mediastinal lymph node dissection.Conclusion: The preoperative precise localization of small pulmonary nodules using Xper-CT-guided coil is an effective and safe technique. It helps in the resection of nodules using VATS. It increases the rate of lung wedge resection with few complications and allows for proper diagnosis with a low thoracotomy conversion rate.