34例局部晚期非小细胞肺癌的外科治疗经验

目的探讨局部晚期非小细胞肺癌的外科治疗效果。方法外科治疗局部晚期非小细胞肺癌34例，其中肺切除加部分胸壁切除9例，右全肺切除加隆凸成形6例、左全肺切除加隆凸成形4例、右上肺叶切除加上腔静脉部分置换1例，右全肺切除加上腔静脉部分切除＋成形5例，左全肺切除加主动脉部分切除成形3例、左全肺切除加部分左心房切除6例。结果全组病例围手术期无死亡，鳞癌21、腺癌13例，术后并发乳糜胸2例，肺不张2例，心率失常4例，喉返神经损伤3例。术后随访时间6—62个月，平均27．3个月，其中1、3、5年生存率分别为82．4％、38．2％、8．8％。结论扩大手术治疗局部晚期非小细胞肺癌可以达到肿瘤的根治切除，并能延长患者的生存时间，但是要严格把握手术指征。

Surgical treatment of 34 patients with locally advanced non-small cell lung cancer

Objective To review the surgical effect of treating locally advanced non small cell lung cancer（LANSCLC）. Method 34 patients with LANSCLC underwent surgical treatment. There were 9 cases for pneumonectomy and chest wall partial resection, 6 cases for right pneumonectomy and tracheo-carinal reconstruction, 4 cases for left pneumonectomy and tracheocarinal reconstruction, 1 cases for right upper lobectomy and superior vena cava replacement, 5 cases for right pneumonectomy and partial resection and reconstruction of superior vena cava, 3 cases for left pneumonectomy and thoracic aorta partial resection and reconstruction, 6 case for left pneumonectomy and left atrium partial resection. Results No patients died in perioperative period, including 21 squamous cell carcinoma and 13 adenocarcinoma, postoperative complications included two chylothorax, three laryngeal nerve injury, two pulmonary closure, four arrhythmia. The duration of fellow-up was 6 to 62 months （ mean, 27.3 months） and the 1, 3, 5-year survival rates were 82.4% ,38.2% ,8.8%. Conclusion Extended resection is a good choice for patients to attain radical resection of tumor and improve the survival time, but the proper surgical indication should be classified strictly.