支气管和肺动脉双袖状肺叶切除术27例

目的:探索肺叶切除加支气管和肺动脉双袖状切除治疗中央型肺癌的手术方法和效果。方法:1995年3 月至2008年7 月，对27例肿瘤同时侵犯上肺叶支气管开口及主支气管和肺动脉干但未侵犯下肺叶的中央型肺癌，采用支气管和肺动脉双袖状肺叶切除技术将肿瘤完整切除，再将保留的下叶支气管与主支气管残端吻合、下叶肺动脉与肺动脉干对端吻合。其中左上肺双袖状切除术21例，右中上肺双袖状切除术5 例，右上肺双袖状切除术1 例。结果:鳞癌20例，腺癌3 例，小细胞未分化癌3 例，腺鳞癌1 例。术后心律不齐3 例，经对症治疗好转；咳痰不畅、阻塞性肺炎、肺不张2 例，经纤支镜吸痰后肺复张良好。突发大咯血死亡1 例。术后生存情况:生存时间1 年者77.78%（21/27），3 年66.67%（8/12），5 年75.00%（6/8）。 结论:支气管和肺动脉双袖状肺叶切除术可最大限度地切除肺肿瘤，且保留了患者的健康肺组织，避免了全肺切除，患者术后的生活质量良好。 

Clinical Experience of Combined Sleeve Resection of Bronchus and the Pulmonary Artery in 27 Patients

Objective: To investigate the methods and results of sleeve resection of bronchus and pulmonary artery in surgical treatment for central lung cancer. Methods: Between March 1995and July 2008, pulmonary artery sleeve resection combined with bronchus sleeve lobectomy was performed in27patients with central lung cancer that involved the bronchi -al opening of an upper lobe of the lungs or the main bronchus and pulmonary artery but didn't involve any lower lobes. Among them, left upper lobectomy was performed in 21cases, right medium-upper lobectomy was performed in 5 cases and right upper lobectomy was performed in 1 case. Results: Squamous cell carcinoma was found in 20cases, adenocarci-noma was found in 3 cases, small cell carcinoma (SCLC) was found in 3 cases, and adenosquamous carcinoma was found in 1 case. After surgery, arrhythmia occurred in 3 cases and obstructive pneumonia and pulmonary atelectasis oc -curred in 2 cases. One death occurred due to hemoptysis. The 1-, 3- and 5-year survival rates were 77.78% (21/27), 66.67% (8/12) and 75.0% (6/8), respectively. Conclusion: The double sleeve resection of bronchus and pulmonary artery can reserve a maximum amount of healthy lung while removing tumors and can at the same time avoid pneumonectomy. This procedure gives patients a better chance for a good quality of life after surgery.