支气管肺动脉袖状成形术治疗侵犯肺动脉干的Ⅲ期肺癌

目的 总结304例支气管肺动脉袖状成形肺叶切除术或合并其它心脏大血管切除重建术治疗侵犯肺动脉干的局部晚期肺癌的临床疗效。方法 1983年2月至2001年12月，对304例肺癌患者施行支气管肺动脉袖状成形肺叶切除或合并其它心脏大血管切除重建术。支气管肺动脉袖状成形左上叶切除术199例；支气管肺动脉袖状成形右肺上叶切除术21例；支气管肺动脉袖状成形右肺中上叶切除术14例；支气管肺动脉袖状成形左上叶切除合并部分左心房切除8例；支气管肺动脉袖状成形右肺上叶切除合并上腔静脉切除人造血管重建术29例；支气管肺动脉袖状成形右肺中上叶切除合并上腔静脉切除人造血管重建术21例；支气管肺动脉袖状成形右肺中上叶切除、气管隆凸切除重建，合并上腔静脉切除人造血管重建术11例；右肺动脉干部分切除、肺动脉圆锥大部切除，人造血管右肺动脉干、肺动脉圆锥重建合并左全肺切除术。结果 本组手术死亡3例，死亡率为1％。发生手术并发症64例次，发生率为21.05%。术后1、3、5和10年生存率分别为81.75%、60.14%、37.21%和24.39%。结论 支气管肺动脉袖状成形肺叶切除或／和合并其它心脏大血管切除重建术均能明显改善局部晚期肺癌的预后，提高治愈率和生存率。

Bronchoplastic procedures and pulmonary artery reconstruction in the treatment of stage Ⅲ lung cancer invading pulmonary artery

Objective To summarize the clinical results of bronchoplastic procedures and pulmonary artery reconstruction or combined with other resection and plasty of heart, great vessels in the treatment of 304 patients with locally advanced lung cancer. Methods From February, 1983 to December, 2001, double sleeve resection and reconstruction of bronchus and pulmonary artery, or combined with other resection of heart, great vessels were carried out in 304 patients with locally advanced lung cancer. The operations included double sleeve left upper lobectomy in 199 cases; double sleeve right upper lobectomy in 21 cases; double sleeve right upper middle lobectomy in 14 cases; double sleeve left upper lobectomy combined with resection of left atrium in 8 cases; double sleeve right upper lobectomy combined with superior vena cava (SVC) resection and reconstruction with Gortex graft in 29 cases; double sleeve right upper middle lobectomy combined with SVC resection and reconstruction in 21 cases; double sleeve right upper middle lobectomy, carinal and SVC resection and reconstruction in 11 cases; left pneumonectomy combined right main pulmonary artery and pulmonary artery trunk resection and reconstruction with Gortex graft in 1 case. Results There were 3 operative deaths. The operative mortality was 1% in this series. Sixty four patients had operative complications. The operative complication rate was 21.05% (64/304). The 1 , 3 , 5 and 10 year survival rates were 81.75%, 60.14%, 37.21% and 24.39% respectively. Conclusion Double sleeve lobectomy or comblined with other resection and reconstruction of heart, great vessels can significantly improve the prognosis and increase the curative rate and long term survival in patients with locally advanced lung cancer.