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。

Surgical treatment for non-small cell lung cancer invading chest wall

Objective To explore surgical methods for non-small cell lung cancer invading chest wall and prognostic factors.Methods One hundred and twenty-seven patients,who were operated on for non-small cell lung cancer invading chest wall in our hospital between 1984 and 2005, were reviewed retrospectively.72 cases were T_3N_0M_0,33 cases were T_3N_1M_0,17 cases were T_3N_2M_0,3 cases were T_4N_0M_0,2 cases were T_4N_1M_0;66 cases were with squamous cell cancer,59 with adenocarcinoma and 2 with large cell carcinoma.Operation procedure were 78 lobectomies,7 bilobectomies,33 pneumonectomies,9 wedge resections or segment resections.En bloc resection were in 46 cases,discontinuous resection of the chest wall were in 13 cases,and extrapleural resection were in 68 cases.Results There was no operative mortality.Operative complications occurred in 11 cases.The 5-year survival rates were 25% and 9% after complete and incomplete resection,respectively(P<0.05).In completely resected patients,nodal involvement(P<0.05) and depth of chest wall invasion(P<0.05) were independent prognostic factors.Conclusion Survival of patients with lung cancer invading chest wall was related to completeness of resection,nodal involvement and depth of invasion.If the tumor seemed to adhere to the chest wall,and not fix to it,the extrapleural resection was performed.If any sign shows that chest wall resection is necessary,the chest wall resection should be performed.