全肺切除术及支气管成形肺叶切除术在非小细胞肺癌治疗中的研究(附64例报告)

背景与目的全肺切除术是最早用于治疗肺癌的肺切除术,但自问世以来一直存在争议。本文旨在分析手术治疗的804例肺癌中的64例全肺切除术(pneumonectomy,P)或支气管成形肺叶切除术(bronchoplasty lobectomy,BPL)病例资料,以探讨其在肺癌治疗中的地位。方法全组手术治疗肺癌共804例,重点分析其中64例P/BPL的临床特点,尤其对生存率进行分析。结果 64例肺癌中肿瘤侵犯肺动脉干(cT4)行全肺切除术25例(右侧6例,左侧19例);因主支气管受累且距隆突<2 cm(cT3)行左全肺切除术4例,右肺上叶支气管成形肺叶切除术19例,左肺上叶及下叶袖状切除术各1例;因主支气管受累但距隆突(?)2 cm(cT1/cT2)而行主支气管成形术13例;右全肺切除并半隆突成形1例(cT4)。64例P/BPL,的患者1年、3年及5年生存率分别为93.6%、69.0%及45.1%,489例同期标准肺叶切除术生存率则分别为92.5%、77.3%及56.9%,两组5年生存率差异无统计学意义(P=0.226)。结论标准肺叶切除术仍是非小细胞肺癌的主要术式,而P/BPL对部分高选择患者在全身治疗的支持下仍是可选术式。

The Evaluation of Pneumonectomy and Bronchoplasty Lobectomy in the Treatment of Non-small Cell Lung Cancer:A Report of 64 Cases

Background and objective Pneumonectomy was the initial successful surgery to treat lung cancer,but there has been being a lot of controversy since its inception.The aim of this study is to evaluate its potential role in the treatment of lung cancer through analyzing the survival for 64 cases underwent pneumonectomy or bronchoplasty lobectomy out of 804 cases underwent lung resection.Methods Eight hundred and four cases of lung cancer underwent pulmonary surgery. We retrospectively reviewed the clinical data,especially foucused on the survival of 64 pneumonectomies or bronchoplasty lobectomies.Results Of the 64 patients,25 underwent pneumonectomy(6 right,19 left) due to involvement of ipsilateral pulmonary artery trunk.Owning to involving ipsilateral main bronchus with the distance of tumor from carina <2 cm,4 pneumonectomies, 19 right upper bronchoplasty lobectomies,1 left upper sleeve lobectomy and 1 left lower sleeve lobectomy were performed.Due to the ipsilateral main bronchus involvement with the distance of tumor from carina >2 cm,13 cases underwent main bronchus bronchoplasty.One performed right sleeve pneumonectomy because of carina involvement.Overall 1-, 3- and 5-year survival rates of 64 pneumonectomies or bronchoplasty lobectomies were 93.6%,69.0%and 45.1%,respectively, and that of 489 standard lobectomies done by the same surgery team in the same period were 92.5%,77.3%and 56.9%,respectively. There was no significant difference in 5-year cumulative survival rates between the two groups(P=0.226).Conclusion Although standard lobectomy remains the main type of surgery,pneumonectomy or bronchoplasty lobectomy is still one of option for the highly selective patients combining the support of induction chemotherapy.