气管或隆凸部肿瘤患者围手术期呼吸问题的处理

目的 总结治疗气管、隆凸部肿瘤患者围手术期呼吸问题的经验,探讨防治这类肿瘤患者术后严重呼吸并发症的方法。方法 回顾性分析38例气管或隆凸部肿瘤患者的术前肺功能改变、手术后并发症、手术方式和围手术期呼吸问题的处理。结果 术前29例（76．3％）患者有肺通气功能障碍。术后21例患者共发生45例次并发症,其发生率为55．3％（21／38）,其中呼吸道并发症占80．8％。17例患者隆凸全肺切除术或隆凸切除及成形术后,发生并发症28例次;21例其他术式的患者,发生并发症17例次。本组死亡4例,死亡率为10．5％。结论 纤支镜引导直视下清醒插管、正确的术式选择、精良的吻合技术、术后呼吸机辅助呼吸、积极抗感染和营养支持是防治围手术期呼吸道并发症的必要手段。     

美托洛尔对老年食管癌患者围术期心脏功能的保护作用

背景与目的：老年食管癌手术患者逐渐增多,围术期如何保护心脏功能,减少老年患者围术期心脏并发症的发生率及其死亡率成为目前亟待解决的问题之一。β受体阻滞剂在围术期的预防性应用被逐渐受到重视。本研究拟探讨美托洛尔对老年食管癌患者围术期心脏功能的保护作用。方法：将择期开胸手术的老年食管癌患者随机分为美托洛尔组（患者从麻醉诱导前至术后72h应用美托洛尔调节心率）和对照组（不给予美托洛尔）,每组患者30例。分别记录两组术前、给药后、麻醉诱导后2min、插管、插管后4min、切皮、进胸、手术开始后1h、手术结束前10min、手术结束、拔管及拔管后15min的血流动力学指标和肌钙蛋白水平：并统计围术期发生心脏并发症的患者例数及术后窦性心动过速例数。结果：对照组患者气管插管时收缩压升高．与术前比较差异有显著性（P〈0．05）：气管插管及气管拔管时心率增快,与术前比较差异有显著性（P〈0．05）。而美托洛尔组患者在上述各时间点收缩压、心率与术前相比差异无显著性（P〉0．05）。对照组患者围术期有3例肌钙蛋白阳性,美托洛尔组无阳性病例,两组比较无显著性差异（P=0．237）。对照组有6例患者发生心脏并发症,美托洛尔组患者未发生心脏并发症．两组比较差异有显著性（P=0．024）。对照组中2例患者发生急性心肌缺血,4例患者发生房颤,两组患者围术期均未发生心肌梗塞及死亡。对照组患者术后发生窦性心动过速有15例,美托洛尔组有6例,两组比较差异有显著性（P〈0．05）。结论：美托洛尔能降低老年食管癌患者围术期心脏并发症及术后窦性心动过速的发生率,有效抑制气管插管和气管拔管导致的心率增快或血压升高。     

280例非小细胞肺癌患者围手术期输血与否的预后关系

目的：研究非小细胞肺癌术后的预后因素及围手术期输血对术后无病生存的影响。方法：回顾性调查了280例手术切除的非小细胞肺癌患者，其中145例（51．8％）患者围手术期接受了输血治疗，采用单因素对数秩检验（log—ranktest）多因素Cox比例风险回归模型进行分析。结果：多因素分析表明，影响预后的主要因素有分化程度、术后分期、围手术期输血。围手术期输血是无病生存的独立预后因素。结论：围手术期输血是非小细胞肺癌独立的不利预后因素，应当尽量避免围手术期输血。     

高龄肺癌58例的外科治疗及围手术期处理

目的：探讨高龄肺癌外科治疗与围手术期处理的有关问题。方法：回顾分析手术治疗的58例70岁以上肺癌病例。结果：手术切除56例(96．6％)，其中根治性切除48例(85．7％)，姑息性切除8例(14．3％)。探查2例(3．4％)。术后并发症50例(86．2％)，围手术期手术死亡2例，病死率3．4％。结论：高龄并非是决定肺癌患者采取手术治疗的禁忌。重视合并症的诊断和治疗、充分的术前准备、合理选择手术时机与手术方式、加强术中与术后监测和防治并发症，是减少术后并发症和病死率、提高根治性切除率、生存率和改善生存质量的关键。     

胸部肿瘤切除术围手术期高血压防治

目的探讨胸部肿瘤切除术围手术期发生高血压的表现特征及处置原则。方法行胸部肿瘤手术治疗患者2008例，合并高血压病者1210例（60．25％），其中肺癌452例（37．36％），胃责门癌410例（33．88％），食管癌348例（28．76％）。术前给予抗高血压治疗，控制收缩压（SP）≤140mmHg（1mmHg=0．133kPa），舒张压（DP）≤90mmHg。术后持续24～72h心电监测，观察心率、呼吸、血压、心电图、血氧浓度变化。结果432例出现心血管并发症（35．7％），其中心律失常323例（26．69％）；心电图sT段异常98例（8．09％），其中发生心绞痛4例。结论围术期高血压与患者精神紧张、麻醉插管、术中刺激以及术后缺氧、疼痛有关。该类患者应术前控制血压；术中加强心肺功能监护，减少刺激；术后观察血压、心率，及时纠正血容量和水电解质平衡，保持血压平稳。     

全肺切除治疗肺癌56例报告

目的 总结56例全肺切除治疗肺癌临床经验，探讨手术指征的掌握和围手术期及术中处理要点。方法 对56例接受全肺切除肺癌病人的临床资料进行回顾性分析。结果 术后并发症发生率10．71％（6／56）。术后1、3、5年生存率分别为80．36％（45／56）、39．02％（16／41）和23．33％（7／30），其中已生存9年和13年各2例。结论 全肺切除并发症发生率较高，但如果围手术期及术中处理得当，术后酌情辅以放／化疗，仍可收到较好效果。     

气管隆凸切除与重建术在肺癌治疗中的应用

背景与目的 手术治疗侵犯隆凸的肺癌需要实施隆凸的切除与重建。本研究的目的是总结和探讨气管隆凸切除与重建手术治疗肺癌侵犯气管隆凸的方法和疗效。方法 回顾性分析73例实行气管隆凸切除与重建术的肺癌患者，其中右全肺切除及隆凸切除22例，右全肺切除气管支气管成形14例，右全肺袖式切除12例，右上叶切除气管支气管成形15例，左全肺袖式切除2例，左全肺切除气管支气管成形8例。结果 本组姑息性手术4例。手术近期死亡4例（5．48％）。手术后1年、3年和5年的生存率分别为75．3％、63．0％和23．3％。结论 严格掌握手术适应证、精心作术前准备、选择适当手术方式和积极的围手术期处理可以提高手术的效果。     

32例双原发肺癌的临床分析

目的：探讨双原发肺癌的诊断及外科治疗手段、方法：对32例双原发肺癌患者的临床资料进行回顾性分析结果：全组32例，其中同时性16例，异时性16例，占同期外科治疗人数的1．13％。同时性双原发肺癌（sDPLC）行肺叶切除10倒．肺叶切除＋局部切除6例，异时性双原发肺癌（mDPLC）第一原发肺癌行手术治疗分别为肺叶切除14例．袖状切除2例。第二原发肺癌行手术治疗分别为肺叶切除13例，局部切除3例、sDPLC术后五年生存率为16．9％．mDPLC组以首发癌计算，五年生存率为62．9％，再发癌五年生存率为323％、组中行肺叶切除者与肺叶＋局部切除者5年生存率为分别为46．6％，25．0％，围手术期死亡率为3．12％结论：手术切除为多原发肺癌的主要治疗方法在保证肺功能的前提下．尽可能行肺叶切除，无论何种术式必须清扫淋巴结。     

隆凸成形术治疗中心型肺癌41例

背景与目的 对累及隆凸中心型肺癌实施隆凸成形术一直是普胸外科研究的难点。本研究拟探讨隆凸成形术在肺癌外科中的应用价值。方法 总结1982～2004年41例中心型肺癌侵犯隆凸的外科治疗资料。41例均行隆凸成形术，其中25例同时行心脏大血管切除，手术采用12种不同类型的隆凸切除重建方式。结果 全组围术期死亡1例（原因为吻合口瘘），术后并发症为各种心律失常12例、肺不张6例、肺部感染5例。呼吸功能衰竭行呼吸机辅助通气5例。本组1、3、5年生存率分别为76．21％、47．23％、26．83％。结论 对侵犯隆凸的中心型肺癌应用隆凸成形术治疗，可以最大限度地切除肺癌组织，最大限度地保留患者的肺功能，术后多学科治疗能提高患者的术后生存率和生活质量。     

低肺功能肺癌患者行伞肺切除术的围麻醉期处理

目的探讨肺功能减退肺癌患者施行全肺切除手术的围麻醉期管理经验。方法回顺性分析23例肺功能减退患者行全肺切除手术在围麻醉期的管理，行右全肺切除者10例。左全肺切除者13例。结果所有患者无一例围麻醉期死亡。结论全面衡量患者情况，积极治疗影响肺功能的疾患。术前进行必要的呼吸功能锻炼，术中适当的麻醉处理和术后全而监护、合理的机械通气，可以减少或避免并发症的发生，使患者安全渡过围麻醉期。     

Postoperative mortality and means of reducing it in patients with lung cancer

The report discusses a 20 year-old experience with surgical treatment for lung cancer. In 1961-1980, the following surgical procedures were carried out in 1,100 cases of lung cancer: pneumonectomy--417 (38%), lobe- and bilobectomy--506 (46%), and exploratory thoracotomy--117 (16%). The range of indications for surgical treatment has been extended within the last 10 years; the percentage of surgical cases older than 60 years has grown from 17 to 35%, with patients older than 70 amounting to 12%. Risk of surgery for lung cancer has been reduced thanks to complex and pathogenetically-grounded therapy given before and immediately after operation as well as application of improved surgical and anesthesiologic support procedures. Among the most frequent death-causing post-operative complications were thromboembolism of the pulmonary artery, bronchial fistula, empyema of the chest and cardiopulmonary failure.     

Chemotherapy is the cornerstone of the combined surgical treatment of lung cancer with synchronous brain metastases

BACKGROUND: Lung cancer accounts for about 50% of brain metastases, of which nearly 25% are eligible for neurosurgery, providing a neurological control rate of up to 70% when followed by whole brain radiation therapy. How to manage the primary lung carcinoma remains elusive. METHODS: We undertook a retrospective study of consecutive patients who underwent surgical resection for synchronous brain metastases from non-small cell lung cancer in a single institution, to determine overall survival and prognostic factors, with particular attention to the treatment of the primary lung tumor. RESULTS: Fifty-one patients underwent surgical resection of synchronous brain metastases from non-small cell lung cancer. Median survival was 13.2 months. Prognosis mainly depended of the treatment of the lung tumor, with a marked survival advantage in the 29 patients receiving a focal treatment (thoracic surgery or radiotherapy), compared to the 22 other patients: median, 1-year, and 2-year survival were 22.5 months, 69%, and 42%, versus 7.1 months, 33%, and 5%, respectively (p<0.001); response to pre-operative chemotherapy before focal treatment was the main favorable prognostic factor (p=0.023), and further identified patients who had benefit from resection of the lung tumor, with a significantly better outcome. CONCLUSIONS: Chemotherapy, by its therapeutic and prognostic value, may be considered as the cornerstone of the combined medical and surgical therapeutic sequence whereby brain metastasectomy is followed by chemotherapy and further focal treatment of the primary lung tumor in responders to chemotherapy.     

Endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of lung cancer and its impact on surgical staging.

PURPOSE: The diagnosis and staging of lung cancer critically depends on surgical procedures. Endoscopic ultrasound (EUS) -guided fine-needle aspiration (FNA) is an accurate, safe, and minimally invasive technique for the analysis of mediastinal lymph nodes (LNs) and can additionally detect tumor invasion (T4) in patients with centrally located tumors. The goal of this study was to assess to what extent EUS-FNA could prevent surgical interventions. PATIENTS AND METHODS: Two hundred forty two consecutive patients with suspected (n = 142) or proven (n = 100) lung cancer and enlarged (> 1 cm) mediastinal LNs at chest computed tomography were scheduled for mediastinoscopy/tomy (94%) or exploratory thoracotomy (6%). Before surgery, all patients underwent EUS-FNA. If EUS-FNA established LN metastases, tumor invasion, or small-cell lung cancer (SCLC), scheduled surgical interventions were cancelled. Surgical-pathologic verification occurred when EUS-FNA did not demonstrate advanced disease. Cancelled surgical interventions because of EUS findings was the primary end point. RESULTS: EUS-FNA prevented 70% of scheduled surgical procedures because of the demonstration of LN metastases in non-small-cell lung cancer (52%), tumor invasion (T4) (4%), tumor invasion and LN metastases (5%), SCLC (8%), or benign diagnoses (1%). Sensitivity, specificity, and accuracy for EUS in mediastinal analysis were 91%, 100% and 93%, respectively. No complications were recorded. CONCLUSION: EUS-FNA qualifies as the initial staging procedure of choice for patients with (suspected) lung cancer and enlarged mediastinal LNs. Implementation of EUS-FNA in staging algorithms for lung cancer might reduce the number of surgical staging procedures considerably.     

两种术式治疗老年Ⅰ期非小细胞肺癌的预后分析

目的:探讨不同手术方式（肺楔形切除和肺叶切除）对70岁以上Ⅰ期非小细胞肺癌患者预后的影响。方法:回顾性分析于2000年1 月至2006年1 月230 例接受手术治疗的70岁以上Ⅰ期非小细胞肺癌患者的临床资料,对其预后和影响预后的临床因素进行分析。结果:单因素分析结果显示,吸烟史、T 分期、手术方式、淋巴结清扫是患者预后的影响因素（P < 0.05）。 多因素分析提示,手术方式、T 分期、淋巴结清扫均是影响70岁以上Ⅰ期NSCLC 患者预后的独立因素（P < 0.05）。 肺楔形切除组5 年生存率42.2%（35/ 83）,肺叶切除组5 年生存率50.3%（74/ 147）,组间差异有统计学意义（P < 0.05）。 进一步分层分析T 1a 的Ⅰ期非小细胞肺癌患者,行肺楔形切除和肺叶切除的5 年生存率差异无统计学意义（51.9% vs . 53.3% ,P > 0.05）。与肺叶切除组相比,肺楔形切除组手术时间短（P = 0.035）、术中失血少（P = 0.031）、术后住院时间短（P = 0.045）。 结论:肺叶切除+ 系统性淋巴结清扫术仍是70岁以上Ⅰ期非小细胞肺癌患者首选的手术方式;T 1a 期患者行肺楔形切除可获得与肺叶切除相近的远期收益,同时肺组织损失较小,对肺功能差的高龄T 1a 期患者推荐行肺楔形切除术。      

Results of surgery in small cell carcinoma of the lung

OBJECTIVE: The experiences published by various groups have re-opened the debate on the role of surgery in the management of patients with small cell lung cancer, especially in those with early stage disease (T1-T2 N0). Our study reports the survival rate of 47 patients with small cell lung cancer treated surgically. PATIENTS AND METHODS: Ours is a prospective study that selected patients with lung cancer recommended for surgery (n=2994) between 1993 and 1997 based on operability criteria accepted by the Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery. We report the clinical as well as pathological stages of the patients with small cell lung cancer (n=47), later analysing the 5-year survival rate after surgery using the Kaplan-Meier method. RESULTS: In 31 patients (66%), resection was complete; 3 patients (6%) received induction treatment and 30 (64%) adjuvant treatment. Five years later, 26% (95% CI 12-40%) of the patients that received surgical treatment were still alive. When we analysed the patients that underwent complete resection, 31% (95% CI 13-49%) survived 5 years or more. In patients at stage Ip (n=15), 36% (95% CI 11-61%) were still living after 5 years. CONCLUSION: Until future studies compare surgery plus chemotherapy versus chemotherapy and radiotherapy, it seems reasonable to offer surgical treatment to those patients with early stage small cell lung cancer (T1-T2-N0).     

新曼彻斯特评分系统对早期非小细胞肺癌患者术后预后的评估价值

目的:探讨术前曼彻斯特评分系统(NMSS)对非小细胞肺癌(NSCLC)患者术后预后的评估价值。方法:本研究纳入2015年12月至2018年12月在河南省胸科医院确诊为早期NSCLC并进行手术切除的患者共278例。NMSS 评分系统根据乳酸脱氢酶（LDH）、碱性磷酸酶（ALP）、血钠、血碳酸氢盐、分期和卡式评分（KPS）分为良好、中等和不良三组,分析NMSS 不同分组以及其他临床指标与术后生存时间之间的关系。结果:278例 NSCLC 患者中,46 例(16.5%)为中等组,70例(25.2%)为不良组,高龄、晚期、未接受放化疗与预后相关,NMSS评分为不良组是预后差的独立危险因素。结论:术前高NMSS评分是影响非小细胞肺癌术后预后的独立危险因素,NMSS评分高提示预后不良。在进行非小细胞肺癌治疗相关选择时,可根据患者的辅助检查结果进行相应的预测评估。     

肿瘤标志物CYFRA21-1、SCC、CEA、NSE、CA125检验在肺癌诊断中的价值

目的:分析肿瘤标志物细胞角蛋白19片段（CYFRA21-1）、鳞状上皮细胞癌抗原（SCC）、癌胚抗原（CEA）、神经特异性烯醇化酶（NSE）以及糖类癌抗原125（CA125）检验在肺癌诊断中的临床应用价值。方法:将2015年11月至2016年11月于我院收治的74例肺癌患者（肺癌组）、74例肺良性肿瘤患者（良性肿瘤组）作为研究对象,同期选择74例到院体检的健康人群作为健康组。三组患者均在空腹状态下抽取4.0 ml静脉血,离心处理后进行实验室检验。对比三组患者中CYFRA21-1、SCC、CEA、NSE以及CA125水平的变化情况。结果:肺癌组的CYFRA21-1、SCC、CEA、NSE以及CA125水平均高于健康组和良性肿瘤组（P<0.05）。非小细胞肺癌患者的CYFRA21-1、SCC、CEA以及CA125水平均高于小细胞肺癌患者。小细胞肺癌患者的NSE水平显著高于非小细胞肺癌患者（P<0.05）。结论:肺癌患者的CYFRA21-1、SCC、CEA、NSE以及CA125水平将会显著增高,通过联合检测CYFRA21-1、SCC、CEA、NSE以及CA125能够在一定程度上提高肺癌疾病的诊断准确率,对于肺癌疾病的临床诊断和筛查具有十分重要的作用。     

Underutilization of radiotherapy for lung cancer in New South Wales,Australia

BACKGROUND:

Lung cancer is the leading cause of cancer death in most developed countries. Radiotherapy is important in its treatment, with an estimated optimal utilization rate between 45% and 68% at initial diagnosis. The objective of this study was to describe radiotherapy practice for lung cancer in New South Wales (NSW), Australia.

METHODS:

Patients with lung cancer were identified prospectively from the NSW Central Cancer Registry (CCR) from November 1, 2001 to December 31, 2002. Questionnaires were mailed to diagnosing and treating clinicians to obtain detailed information on diagnosis, staging, referrals, and treatment. The authors describe referral for and receipt of radiotherapy treatment.

RESULTS:

Of 1812 patients with lung cancer patients who were identified, 943 patients (52%) were referred for radiotherapy, 846 patients (47%) received a radiotherapy questionnaire, and 727 patients (40%) received radiotherapy. Compared with optimal radiotherapy, there was less curative radiotherapy to the primary site (20% actual vs 50% optimal), and there was more palliative radiotherapy to metastatic sites (36% actual vs 11% optimal). The greatest shortfall in radiotherapy use was observed in patients who had limited stage small cell lung cancer (46% actual vs 94% optimal). The use of combined‐modality treatment for stage III nonsmall cell lung cancer and for limited stage small cell lung cancer was uncommon.

CONCLUSIONS:

There is underutilization of radiotherapy for lung cancer in NSW, especially in small cell lung cancer. The use of combined‐modality treatment for potentially curable lung cancers is suboptimal. These issues have to be addressed to improve survival and quality of life for patients with lung cancer. Cancer 2010. © 2009 American Cancer Society.     

Surgical management of cerebral metastases from non-small cell lung cancer

AIMS AND BACKGROUND: The objective of the study was to assess the efficacy of surgical resection of solitary brain metastasis in patients with non-small-cell lung cancer. METHODS AND STUDY DESIGN: We report a retrospective analysis of 32 patients with single brain metastasis surgically excised at our hospital. All but one patient underwent postoperative whole brain radiation therapy. RESULTS: The median survival of patients was 12.5 months postoperatively (mean, 17 months), and the overall 1-year survival was 53%. Thirteen patients had recurrence of brain metastasis: 6 of 13 underwent reoperation for the recurrent lesion, and 1 of the 6 patients had a third craniotomy. Baseline characteristics, which significantly influenced survival, included age less than 60 years, tumor histology (ie, adenocarcinoma), and treatment of the primary lung cancer. The analysis did not yield any significant differences between treatment modalities. CONCLUSIONS: Our findings correspond well with those reported in the literature and suggest that surgical resection of single brain metastasis in patients with non-small cell lung cancer can improve survival over conservative management. Furthermore, surgical treatment of the primary tumor and the single brain metastasis, combined or not with radiotherapy and chemotherapy, represents an approach that merits further investigation with more patients and a prospective longitudinal design.