袖式切除治疗82例肺癌患者的临床分析

背景与目的:支气管袖式切除和/或肺血管袖式切除在切除肿瘤的同时能最大限度地保留健康肺组织,为肺癌外科治疗提供了一种手术方式。本研究旨在探讨肺癌袖式切除的技术问题、手术结果、术后并发症及患者术后生存情况。方法:选择2001年6月至2006年12月,在浙江省肿瘤医院行袖式切除的82例中央型肺癌患者,其中23例同时行肺动脉血管袖式切除,2例单独行肺血管袖式切除。所有患者术中行系统淋巴结清扫。观察淋巴结清扫情况以及术后并发症的发生情况,用Kaplan-Meier法对患者的生存情况进行分析。结果:82例患者清扫9～57个淋巴结,平均20个,中位数19个。淋巴结N1转移49例,占59.8%;N2转移21例,占25.6%。2例(2.4%)患者在围手术期死亡,无支气管吻合口瘘发生。全组中位生存期26个月。1、2、3、5年生存率分别为78.4%、52.5%、39.1%、23.4%。男性和女性、<60岁与≥60岁患者的1、3、5年生存率均无显著性差异(P>0.05)。而N1(-)N2(-)、N1( )N2(-)、N2( )患者的1、3、5年生存率差异有显著性(P<0.01);Ⅰ期、Ⅱ期、ⅢA期、ⅢB期患者的1、3、5年生存率差异也有显著性(P<0.01)。结论:肺癌袖式切除手术死亡率以及与吻合相关并发症发生率低,可在掌握适应证的情况下代替全肺切除。系统淋巴结清扫不增加手术并发症和死亡率。袖式切除术后患者的生存与淋巴结转移状况以及临床分期有关,而与性别、年龄无关。

Sleeve resection for lung cancer: a report of 82 cases

BACKGROUND & OBJECTIVE: Bronchial sleeve resection and/or pulmovascular sleeve resection can maximize preservation of normal lung tissues after tumor resection, which provides a resection mode for lung cancer surgery. This study was to investigate the technique, operative results and survival of lung cancer patients after sleeve resection. METHODS: Eighty-two central lung cancer patients underwent sleeve resection in Zhejiang Cancer Hospital from Jun. 2001 to Dec. 2006. Among them, 23 underwent concomitant pulmovascular sleeve resection, 2 underwent pulmovascular sleeve resection alone. All patients received systematic lymph node dissection. The results of lymph node dissection and the occurrence of postoperative complications were studied. The survival of patients was analyzed by Kaplan-Meier method. RESULTS: An average of 20 lymph nodes (range, 9-57; median, 19 ) were dissected from 82 patients. Of the 82 patients, 49 (59.8%) were at stage N1, 21 (25.6%) at stage N2. Two (2.4%) patients died 2 and 3 days after operation. No bronchial anastomotic leakage occurred. The 1-, 2-, 3-, and 5-year survival rates were 78.4%, 52.5%, 39.1%, and 23.4%, respectively, with a median survival of 26 months. There were no significant differences in 1-, 3-, and 5-year survival rates between male and female patients, or between the patients aged of <60 and > or =60. The differences in 1-, 3-, and 5-year survival rates among N1(-) N2(-), N1 (+) N2(-), N2(+) patients, and among stageI, II, IIIA, IIIB patients were significant (P<0.01). CONCLUSIONS: Perioperative mortality and the incidence of anastomosis-related complications for lung cancer patients after sleeve resection are low. Sleeve resection is an alternative to pneumonectomy for certain indications. Systematic lymph node dissection does not increase operative complications and mortality. The survival of lung cancer patients after sleeve resection is conelated to lymph node metastasis and clinical stage, but has no correlation to gender or age.