肺癌外科治疗

文章包括两大部分。首先通过近十年文献复习，报告了国内肺癌外科治疗概况。第二部分总结了中国医学科学院肿瘤医院胸外科2004例肺癌的外科治疗结果。国内较大组综合资料表明，切除率为80．4％～91．4％，并发症发生率为1．7％～22．3％，手术死亡率为0．8％～3．1％，切除后5年生存率为30．1％～42．0％。病理类型分布如下：鳞癌47．5％，腺癌32．6％，小细胞癌10.3％，大细胞癌3．3％，其它5．8％。P-TNM分期情况：Ⅰ期34．8％，Ⅱ期21.3％，Ⅲ期46．3％，Ⅳ期0.4％。手术类别包括：肺叶（合双叶）切除70．3％，全肺切除20．0％，部分切除（楔形或段）5．1％，袖式肺叶切除4．0％，隆突成形切除0．6％。小于40岁肺癌病人的临床特点：误诊率高达76．6％，切除率低，平均76．3％，5年生存率仅23．0％。年青病例的病理类型以腺癌最多达39．3％，小细胞肺癌其次28．4％，鳞癌仅24．0％。老年人（大于60岁）肺癌的外科临床特点：较高的并发症发生率27．3％以及手术死亡率2．4％，5年生存率31．3％，则与全年龄组无差别，为改进疗效，强调并存疾病的治疗及围手术期的护理。肿瘤医院胸外科33年收治2004例肺癌，男1571例，女433例，平均年龄53．9岁（20～80岁）。病理类型：基本符合国内综合资料。P—TNM分期?

The surgical Treatment of Lung Caner

Collevtive data in China within recent ten years gave the results of surgery in lung caner as follows;an overall resectability of 80. 4% ~91. 4%; an operative morbidity of 1. 7% ~22. 3%; a mortality of 0.8%~3.1 %; a 5 - yr survival rate of 30. 1 % ~42. 0%. Th distributtion of pathological types was: squamous cell carcinoma 47. 5%, adenocarcinoma 32. 6%, small cell carcinoma 10. 3%, larg cell carcinoma 3. 3% and miscellaneous,5.8%. The p-TNM staging gave the following results: stage I 34.8%, stage Ⅱ 21. 3%, Stag Ⅲ46.3%, StageⅣ0. 4%. The mode of resecion performed consisted of : regular lobectomy 70. 3%, pneumonectomy 20. 0%.wedge and segmentectomy 5.1 %, sleeve lobectomy 4. 0%, carino - plastic lung resection 0. 6%.Tha results of 2004 lung cancer petients admitted to authors' department over a span of 33 years were reviewed. There were 1571 males and 433 females. Their pethological classification was more or less similar to that in the above mentioned collective data. The p - TNM staging in 1721 resected cases showed: stage O and I 50. 1 %,stage Ⅱ 23.6%, Stag Ⅲa 23. 3%, stage Ⅲb 2. 0% and stage Ⅳ 1.2%. The overall asetability was 85. 9%;operative morbidity was 15. 7% and the 30 - day mortality was 1. 3%. The operative modes performed included regular lobectomy 1243 cases (72. 2% ), pneumonectrmy 281 cases (16. 3% ), sleeve lobectomy 155 cases (9. 0% )and economic resection 42 cases (2. 5% ). Major factors influencing the long- term survival rate were: nature of resection, mode of resection, status of lymph node metasiss, tumor size and degree of extension, pathological types and p- TNM staging.Authors suggesed that for non - small cell lung cancer surgery is indicated among stage Ⅰ,Ⅱ and Ⅲa patients,while in small cell lung cancer, surgery should be limited to stage Ⅰand Ⅱ patients.Postoperetive chemotherapy should be part of the treatment program for small cel carcinoma.Authors also emphasize the substitution of pneumonectomy by sleeve lobectomy whenever identical radicality could be achieved.