气管隆凸、支气管、肺动脉成形术治疗肺癌

背景与目的　气管隆凸、支气管、肺动脉成形术在国内外应用广泛,这种手术扩大了肺癌手术适 应证,保留更多的健康肺组织,使一部分心肺功能差的中心型肺癌患者可获得比全肺切除术更好的治疗效果。 本研究旨在探讨中心型肺癌进行选择性扩大切除手术的可行性和手术适应证。方法　1979年11月至2003 年1月对50例中心型肺癌施行肺叶或全肺切除术,同时行气管隆凸、支气管或肺动脉成形手术。本组气管隆 凸、支气管成形术48例,肺动脉成形术2例。结果　本组发生手术并发症4例(8.0%),死亡2例(4.0%)。 本组病例均进行长期随访,术后1、3、5、10年生存率分别为89.4%(42/47)、57.1%(20/35)、42.1%(8/19)和 25.0%(2/8)。结论　部分中心型肺癌选择性进行肺叶或全肺切除的同时进行气管隆凸、支气管或肺血管成 形术是可行的,这种手术能最大限度地清除病灶和保留健肺,有利于延长生存期。

Tracheo-carinal reconstruction,bronchoplasty and vascular reconstruction in the treatment of lung cancer

Background and objective Reconstruction of carina, bronchoplasty and arterioplasty are widely used to extend the indication of lung cancer operation. Because these procedures preserve as many healthy lung tissues as possible, their therapeutic effect is better than pneumonectomy in many central lung cancer cases with poor cardiopulmonary function. The aim of this study is to explore the feasibility and indication of extended resection in selected patients with centrally located lung cancer. Methods From November, 1979 to January, 2003, lobectomy or pneumonectomy combined with extended resection of tracheo-carina, bronchus or vessels were performed in 50 patients with centrally located lung cancer. Tracheo-carinal reconstruction and bronchoplasty were performed in 48 cases, and pulmonary arterioplasty in 2 cases. Results Postoperative complications occurred in 4 patients (8.0%), and operative death occurred in 2 patients (4.0%). All the 48 patients were followed up from 1 to 10 years. The 1-, 3-, 5- and 10-year survival rate was 89.4% (42/47), 57.1% (20/35), 42.1% (8/19) and 25.0%(2/8) respectively. Conclusion Extended pulmonary resection combined with tracheo-carinal reconstruction, bronchoplasty and vascular reconstruction is feasible for selected patients with centrally located lung cancer. It is helpful to prolong the long-term survival of patients with lung cancer.