晚期支气管肺癌侵犯不同部位的外科治疗

目的 探讨晚期支气管肺癌侵犯不同部位的外科处理方法。方法 隆突切除重建６ 例、支气管肺叶肺动脉双袖切除重建１８例、支气管肺叶袖状切除重建３８例（含隆突切除重建３ 例）、心包内肺切除 ５２例、胸膜全肺切除 ２８例。结果 全组无手术死亡，未发生吻合口瘘，无其他严重并发症发生。随访：隆突切除重建１例术后１４６ｄ因肺部感染呼吸衰竭死亡，其余５例术后生存最长已超过３年，最短为１．５年。１、３、５年生存率分别是：支气管肺动脉双袖状切除重建９４．４％、４４．４％、２７．８％，支气管肺叶袖状切除重建９７．４％、５２．６％、３４．２％，心包内肺切除８０．８％、２６．９％、１５．４％。胸膜全肺切除平均存活期１８个月，中位生存期１７个月，水胸、胸痛及上腹痛未复发。结论 采用不同的手术方法，治疗晚期肺癌，符合肺癌手术的“两个最大限度”原则，可扩大肺癌的手术指征，减少开胸探查率，提高病人生活质量，为晚期肺癌病人提供多学科综合治疗创造了条件。

Surgical treatment for lung cancer of advanced stage with invasion else

Objective To research the surgical treatment for lung cancer of advanced stage with invasion else. Methods The 6 patients were subjected to operation with reconstruction and resection of carina, 18, double sleeve resection of pulmonary artery and bronchus, 38, bronchus sleeve resection, 52, intraparieardial pneumonectomy, and 28, pleura-total pneumonectomy. Results No death and bronchial anastomotic leakage. In the follow-up, one patient died of respiratory failure brought by pneumonia after reconstruction and resection of carina after 146 days,other 5 patients survived from 1.5 years to more than 3 years.The 1,3 and 5 year survival rates separately: double sleeve resection of pulmonary artery and bronchus were 94.4%,44.4% and 27.8%, bronchus sleeve resection were 97.4%, 52.6% and 34.2%, intrapericardial pneumonectomy were 80.8%, 26.9% and 15.4%.The median survival period of pleura-total pneumonectomy was 17 months,but hydrothorax, thoracalgia and epigastralgia was not recur. Conclusion Using the different operation program treating the lung cancer of advanced stage by its type accords with the principle :ensure more radical resection of lung cancer, maximal preservation of functional pulmonary parenchym, and expands the operation indication of lung cancer. Exploratory thoracotomy＇s rate is reduced. The living quality of the patients is improved. It offered the opportunity of complex treatments for patients suffered from lung cancer of advanced stage.