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.     

肺癌心包内处理血管的全肺切除手术59例

目的 探讨心包内处理血管的全肺切除术在提高肺癌手术疗效中的作用。方法 对59例肺癌病人行心包内处理血管的全肺切除术,此术式占同期全肺切除术41.8%(59/141例）。结果 手术死亡2例（3.4%),主要并发症13.6%.1、3、5年生存率分别为：86.0%(49/57例）,31.6%(18/57例）和26.3%(15/57例）。3例小细胞肺癌无1例生存逾3年。死亡率和并发症发生率与标准全肺切除术相比差异无显著性,预后与标准全肺切除术亦相近。结论 心包内处理血管的全肺切除是安全的,可提高肺癌切除率,改善生活质量,提高5年生存率。在临床上有应用价值。     

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。     

肺癌肺切除术围术期系统化护理体会

目的总结肺癌肺切除术围术期系统化护理的体会。方法对26例接受肺切除术的肺癌患者实施围术期系统化护理,观察护理效果。结果本组26例患者均顺利完成手术。随访6~12个月,术后发生并发症5例(19.23%),其中心律失常2例、切口感染1例,支气管胸膜瘘1例,均经对症治疗后痊愈。1例高龄患者术后发生急性呼吸衰竭死亡,未发生其他并发症。结论加强肺癌肺切除术患者的围术期系统化护理,能减少术后并发症,降低病死率,改善手术治疗效果。     

以同侧余肺切除完成全肺切除22例

报告以同侧余肺切除完成全肺切除病例２２例，占我院肺手术的０．３６％（２２／６０９４）。距第一次肺手术时间１个月至２６年。主要手术适应证：（１）肺结核复发；（２）支气管扩张症残留症状；（３）肺癌复发；（４）治疗肺切除术后余肺严重并发症。术后主要并发症是支气管胸膜瘘。我们认为，严格手术指征、了解第一次肺手术的全过程、提高手术技巧是余肺切除术取得成功的关键。     

全肺切除术后并发症的预防与护理

目的探讨全肺切除术后并发症的预防与护理方法。方法对32例原发性肺癌行全肺切除术患者,术前、术中采取积极有效措施预防心律失常、血胸、急性肺水肿、支气管胸膜瘘、呼吸衰竭等并发症;术后密切观察病情变化,采取针对性措施,杜绝并发症发生。结果患者均顺利完成手术,术后发生心律失常1例,血胸3例,急性肺水肿2例,支气管胸膜瘘1例;并发症发生率为21.9%,均治愈。结论有效预防和精心护理可防止原发性支气管肺癌全肺切除术后并发症发生,提高手术效果。     

局限性胸膜肺切除术治疗伴癌性胸水非小细胞肺癌的远期结果

目的　评估局限性胸膜肺切除术治疗伴癌性胸水非小细胞肺癌的远期效果和应用价值。　方法　对1994年 1月至 1998年 12月间采用该术式治疗的 16例伴癌性胸水肺癌患者进行定期随访 ,了解患者生活质量、复发情况和生存时间。计算术后中位数复发和中位数生存时间。　结果　本组无手术死亡 ,无严重手术并发症。术后胸闷、呼吸困难、胸腹壁疼痛症状明显缓解 ,恶病质迅速消失 ,未见胸水复发 ,但后期均发生远处脏器转移。术后肿瘤复发距手术时间 3～ 36个月 ,中位数复发时间 12个月。随访至 2 0 0 0年 8月 ,所有病例死亡 ,存活期 7～ 39个月。存活 1年以上 15例 ,1年生存率 94% ;存活 18个月以上 13例 ,生存率 81% ;存活 2年以上 7例 ,生存率 44 % ;存活 3年以上 2例 ,生存率 13% ;中位数生存期 2 1.5个月。　结论　此术式控制胸水、缓解症状效果肯定。术后晚期均发生远处脏器转移 ,但其中位数生存期明显长于仅做姑息性肺内癌灶切除或内科治疗患者 ,且长于全胸膜肺切除术。本术式有推广应用价值     

全肺切除术后并发症的预防与护理

目的 探讨全肺切除术后并发症的预防与护理方法.方法 对32例原发性肺癌行全肺切除术患者,术前、术中采取积极有效措施预防心律失常、血胸、急性肺水肿、支气管胸膜瘘、呼吸衰竭等并发症;术后密切观察病情变化,采取针对性措施,杜绝并发症发生.结果 患者均顺利完成手术,术后发生心律失常1例,血胸3例,急性肺水肿2例,支气管胸膜瘘1例;并发症发生率为21.9%,均治愈.结论 有效预防和精心护理可防止原发性支气管肺癌全肺切除术后并发症发生,提高手术效果.     

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。     

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。     

Completion pneumonectomy: experience in eighty patients.

OBJECTIVE: Because completion pneumonectomy is a procedure reputed to place patients at risk, we reviewed our results with the objective of identifying factors that influence complications and survival. METHODS: In a 25-year period, 80 completion pneumonectomies were performed after first operations for 17 cases of benign disease and 63 cases of lung cancer (89% stages I and II), with 7 of the latter patients receiving postoperative radiotherapy. Completion pneumonectomy was performed in 18 cases of benign disease and 62 cases of lung cancer: 28 second primary cancers, 26 recurrent cancers, 3 metastases, and 5 primary cancers in patients previously operated on for benign disease. RESULTS: No intraoperative deaths occurred. Postoperative mortality rates were 5% for the entire series, 6.4% for patients operated on for cancer, and 0% for patients operated on for benign diseases. Patients previously irradiated and those operated on for infectious disease were at risk for postoperative empyema and fistula formation. In the cancer treatment group the actuarial 5-year survival was 36%, without significant difference between patients with recurrent and second primary lung cancers. The actuarial 5-year survivals were 51% for patients with stage I disease, 42% for patients with stage II disease, and 18% for patients with stage IIIA disease (P <.05). CONCLUSIONS: Completion pneumonectomy can be performed with an acceptable operative mortality rate and offers a second chance for cure to patients with cancer. Patients previously irradiated and those requiring completion pneumonectomy for infectious benign disease are at risk for postoperative complications.     

Completion pneumonectomy for recurrent or second primary lung cancer

OBJECTIVE: We studied 8 patients undergoing completion pneumonectomy for recurrent or second primary lung cancer. METHODS: Subjects were men who averaged 62 years of age. Of these 6 had p-stage I, and 2 p-stage II disease at initial operation. At the second operation, we diagnosed 3 with second primary lung cancer and 5 with recurrent lung cancer. We predicted postoperative pulmonary function by calculating the predicted forced expiratory volume in 1.0 second (FEV1.0) from residual numbers of subsegments after completion pneumonectomy. All predicted FEV1.0 in our 8 cases ranged from 544 to 926 (773 +/- 144) ml/m2. RESULTS: Six patients experienced postoperative complications and morbidity was 75%. One patient undergoing completion sleeve pneumonectomy after radiation therapy for local carina recurrence died on 7th postoperative day due to anastomotic dehiscence and pneumonia. Overall operative mortality was 12.5% (1/8). Four remain alive and actuarial 5-year survival was 37.5%. CONCLUSIONS: Careful consideration is needed in determining operative indications for completion pneumonectomy for patients after radiation therapy. Patients with recurrent squamous cell carcinoma who have p-stage I disease at initial operation and those with second primary lung cancer and p-stage I or II disease can expect relatively a long-term survival, and we concluded that completion pneumonectomy could be conducted in these cases with a satisfactory prognosis.     

Completion pneumonectomy in cancer patients: experience with 55 cases.

OBJECTIVE: Analysis of a single institution experience with completion pneumonectomy. METHODS: From 1989 to 2002, 55 consecutive cancer patients received completion pneumonectomy (mean age 62 years; 25-79). Indications were bronchogenic carcinoma in 38 patients (4 first cancers, 8 recurrent cancers, 26 second cancers), lung metastases in three (one each from breast cancer, colorectal neoplasm and lung cancer), lung sarcoma in one, and miscellaneous non-malignant conditions in 13 patients having been surgically treated for a non-small cell lung cancer previously (bronchopleural fistula in 4, radionecrosis in 3, aspergilloma in 2, pachypleura in 1, massive hemoptysis in 1 and pneumonia in 2). Before completion pneumonectomy, 50 patients had had a lobectomy, three a bilobectomy, and two lesser resections. The mean interval between the two procedures was 51 months for the whole group (1-469), 60 months for lung cancer (12-469), 43 months for pulmonary metastases (21-59) and 29 months for non-malignant disorders (1-126). RESULTS: There were 35 right (64%) and 20 left (36%) resections. The surgical approaches were a posterolateral thoracotomy in 50 cases (91%) and a lateral thoracotomy in five cases (9%). Intrapericardial route was used in 49 patients (89%). Five patients had an extended resection (2 chest wall, 1 diaphragm, 1 subclavian artery and 1 superior vena cava). Operative mortality was 16.4% (n=9): 11.9% for malignant disease (n=5) and 30.8% for benign disease (n=4) Operative mortality was 20% for right completion pneumonectomies (n=7) and 10% for left-sided procedures (n=2) Twenty-three patients (42%) experienced non-fatal major complications. Actuarial 3- and 5-year survival rates from the time of completion pneumonectomy were 48.4 and 35.2% for the entire group. Three- and five-year survival for patients with bronchogenic carcinoma were 56.9 and 43.4%, respectively. CONCLUSIONS: These results suggest that completion pneumonectomy in the setting of lung malignancies can be done with an operative risk similar to the one reported for standard pneumonectomy. In contrast, in cancer patients, completion pneumonectomy for inflammatory disorders is a very high-risk procedure.     

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     

Completion pneumonectomy for recurrent lung cancer. Analysis of 59 cases]

From 1973 to 1989, a total of 59 consecutive patients with recurrent lung cancer had completion pneumonectomy. Completion pneumonectomy was done on the right side in 35 patients and left side in 24. The median interval between the first pulmonary resection and completion pneumonectomy for patients was 35 months (5 m-9.5 y). In this series postoperative complications and mortality were comparable to those for routine pneumonectomy. The 1, 3, 5 and 10 year survival rates were 88.5%, 30.2%, 21.4% and 16.7% respectively. None of those patients with histologically proved gross tumor remaining in the hemithorax at the time of reoperation survived longer than 2 years. The authors emphasized that the planning for such an operation must be done meticulously but aggressively. It is obvious that incomplete surgical resection of bronchial carcinoma should be avoided either at initial operation or at completion pneumonectomy because of poor prognosis.     

Video-assisted thoracic surgery for metachronous lung cancer

Of 1,391 patients who underwent operation for primary lung cancer between 2000 and 2009, 50 patients (3.6%) had a past history of pulmonary resection for lung cancer. Three patients underwent completion pneumonectomy by thoracotomy and in the other 47 patients video-assisted thoracic surgery (VATS) was performed. We considered 42 cases (3 of completion pneumonectomy and 39 of VATS) to be metachronous lung cancer and 8 cases of VATS to be recurrence by detailed histologic assessment. We examined 39 cases of metachronous lung cancer resected by VATS. The patients were aged 68 +/- 8 years and 4 patients were aged 80-years or more. The surgical procedures performed were lobectomy in 4 patients, segmentectomy in 3, and wedge resection in 40. The operation time was 121 +/- 66 minutes and the blood loss was 67 +/- 140 ml. There were no major complications. We registered 6 deaths during follow-up; 3 were due to disease progression and 3 were due to other causes. The survival rate of the 42 patients including 3 patients who underwent completion pneumonectomy was 74.9% at 5 years. Early detection of metachronous lung cancer and surgical resection offers a favorable prognosis.     

Surgical outcome of tracheobronchial reconstruction for lung cancer

We retrospectively evaluated the surgical outcome after sleeve lobectomy and pneumonectomy with tracheobronchial reconstruction for lung cancer. From 1993 to 2008, 46 patients with primary lung cancer underwent these surgical procedures. Seventeen patients (37%) received induction therapy, 15 received chemotherapy, while chemoradiotherapy or radiotherapy alone were received by one patient each. Sleeve lobectomy without carinal resection was performed in 41 patients. Carinal resection with 2 sleeve pneumonectomies was performed in 5 patients. There were no operative deaths. Bronchopleural fistula occurred in one patient, who required completion pneumonectomy. One patient presented local mucosal necrosis in the anastomotic site and was managed conservatively. Two patients had bronchial strictures as late complications and successfully dilated by a balloon using bronchoscopy. Overall 5-year and 10-year survival rates were 54% and 48%, respectively. No recurrence developed at any anastomotic site. The results showed that sleeve lobectomy and pneumonectomy with tracheobronchial reconstruction can be performed with low mortality and bronchial anastomotic complication rates. As well, local control of the tumor was satisfactory.     

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.     

Long-term outcomes and risk factor analysis after pneumonectomy for active and sequela forms of pulmonary tuberculosis.

OBJECTIVE: The prevalence of pulmonary tuberculosis remains high in several areas of the world, and pneumonectomy is often necessary to treat the disease. We retrospectively analyzed the morbidities, mortalities, and long-term outcomes after pneumonectomy for the treatment of active tuberculosis or its sequelae. MATERIALS AND METHODS: Between 1981 and 2001, 94 patients underwent either pneumonectomy or pleuropneumonectomy for the treatment of tuberculosis. The patients included 44 males and 50 females and the mean age was 40 (16-68) years. The pathology included destroyed lung in 80, main bronchus stenosis in ten, and both lesions in four. Surgical procedures performed were pneumonectomy in 47, pleuropneumonectomy in 43, and completion pneumonectomy in four. RESULTS: One patient died postoperatively due to empyema. Twenty-three complications occurred in 20 patients: empyema in 15 (including seven bronchopleural fistulae), wound infections in five, and other complications in three. Univariate analysis revealed the presence of empyema, pleuropneumonectomy, prolonged operation time, old age, and intraoperative contamination as risk factors of postpneumonectomy empyema; it also showed that low preoperative FEV(1) and postoperative persistent positive sputum AFB were risk factors of bronchopleural fistula. In multivariate analysis, old age and low preoperative FEV(1) were risk factors of empyema while low preoperative FEV(1), positive sputum acid-fast bacilli, and the presence of aspergilloma were risk factors of bronchopleural fistula. There were 12 late deaths. Actuarial 5- and 10-year survival rates were 94+/-3% and 87+/-4%, respectively. CONCLUSION: Pneumonectomy could be performed with acceptable mortality and morbidity, and could achieve satisfactory long-term survival for the treatment of tuberculosis. In patients with risk factors, special care is recommended to prevent postoperative empyema or bronchopleural fistula.