局部晚期肺癌的扩大切除术与综合治疗

目的探讨根治性扩大肺切除手术辅以多学科综合治疗在Ⅲ期局部晚期肺癌治疗中的应用价值。方法回顾性总结1988年2月至2002年12月本院89例Ⅲ期局部晚期肺癌病例的治疗资料。其中胸壁、膈肌部分切除术29例，跨叶侵犯肺叶部分切除10例，跨叶侵犯肺癌全肺切除5例，胸主动脉壁切线切除、胸主动脉成形术3例，胸主动脉部分切除、人造血管重建术2例，左心房部分切除术16例，上腔静脉部分切除、上腔静脉心包片成形术9例，上腔静脉切除、上腔静脉人造血管重建术3例，肺动脉袖式切除或成形术16例；56例患者接受过术前新辅助化疗，其中5例为3周期，余均为2周期，术后均行化疗和（或）放疗。结果术后发生并发症包括急性肺水肿2例，肺部感染10例，心律紊乱3例，呼吸衰竭3例；1例因肺部感染死亡，1例因呼吸衰竭死亡，死亡率为2．24％；术后随访时间为7个月～18年，1、3、5年生存率为75．6％、50．3％、26．1％。结论根治性扩大肺切除手术辅以多学科综合治疗能明显提高Ⅲ期局部晚期肺癌患者的生存率。

Extended Resection and Multimodality Treatment of Locally Advanced Lung Cancer

Objective To explore the value of radical and extended resection combined with multimodality treatment for Ⅲ lung cancer. Methods Eighty-nine cases of radical and extended resection in the surgical treatment of pathological stage Ⅲ lung cancer from Feb. 1988 to Dec. 2002 in our hospital was reviewed. In these cases, 29 underwent partial resection of chest wall and diaphragm, 15 with lung cancer invasioning beyond interlober pleura underwent wedge excision or total pneumonectomy, 3 underwent aorta thoracalis wedge excision and reconstruction,2 underwent aorta thoracalis partial resection and reconstruction with gortex graft, 16 underwent partial left atrium excision, 9 underwent wedge excision of superior vena cava and reconstruction with heart-sac piece, 6 underwent partial of superior vena cava and reconstruction with gortex graft,16 underwent pulmonary artery plasty operation or wedge excision of pulmonary artery; 6 accepted neoadjuvant chemotherapy before operation, 5 received 3 cycles, he rest accepted 2 cycles, and atients accepted chemotherapy or（and） radiation. Results Eighteen had operative complications. Acute pulmonary edema happened in 2 cases, lung infection in 10, arrhythmia in 3, and respiratory failure in 3. The early death was in 2 cases （operative mortality 2.24% ） ,the causes of death were ： lung infection in 1 case and respiratory failure in 1. The 1,3 and 5 year survival rates were 75.6 %, 50.3 % and 26.1% respectively. Conclusion Radical and extended resection with multimodality treatment for Ill locally advanced lung cancer could increase the patients＇s survival rate and the life quality conspicuously.