肺癌切除术后局部复发的外科再治疗

目的　探讨肺癌术后复发外科再治疗的可行性及手术适应证。　方法　对 2 0例肺癌术后复发再手术患者的临床资料进行回顾性分析。　结果　本组患者的手术切除率及根治性切除率分别为 75 0 % (15 / 2 0 )和 80 0 % (12 / 15 ) ;手术病死率及手术并发症发生率分别为 0和 2 0 0 % ;平均手术出血量 945ml;胸膜腔粘连及心包内处理血管患者的比例分别为 10 0 0 %和 5 3 3 % ;1、3、5年生存率分别为 94 1%、41 7%和 40 0 %。单纯探查及姑息性肿瘤切除患者的平均术后生存期为 15 0个月 ,明显短于根治性切除患者的 5 6 9个月 (P <0 0 5 )。N0 患者的平均生存期为 (10 5 3± 82 0 )个月 ,明显长于N1、N2 患者的 (11 4± 6 0 )个月 (P <0 0 5 )。　结论　由于胸膜腔的广泛粘连 ,肺癌术后复发再手术多较困难 ,但只要及时发现复发并合理地选择适应证 ,外科再切除可延长患者的生存期。

Re-surgical treatment for postoperative local recurrence of lung cancer

OBJECTIVE: To evaluate the feasibility of re-surgical treatment for postoperative recurrence of lung cancer and its indications. METHOD: The clinical data of 20 patients treated again surgically after recurrence of lung cancer were analyzed retrospectively. RESULTS: The resectability, radical resectability, morbidity, and mortality were 75.0% (15/20), 80.0% (12/15), 20.0% and 0.0% respectively. The mean operative blood loss was 945 ml. The percentages of patients with pleural adhesion and intrapericardial dissection were 100.0% and 53.3% separately. The 1-year, 3-year and 5-year survival rates were 94.1%, 41.7% and 40.0%. The mean survival time of the patients receiving exploration or palliative resection was 15.0 months, shorter than the 56.9 months of the patients having radical resection. The mean survival time of the patients with N(0) was (105.3 +/- 82.0) months, much longer than (11.4 +/- 6.0) months of the patients with N(1) or N(2). CONCLUSION: Because of extensive adhesion, operations for postoperative recurrence of lung cancer are difficult, but if recurrence is found in time and operative indication is appropriate, re-surgical treatment can prolong the patients' survival time.