肺切除并扩大性左心房部分切除治疗局部晚期肺癌疗效分析

目的探讨扩大性外科手术治疗左心房和心包内肺静脉受侵犯的局部晚期肺癌的效果。方法1998年6月至2004年11月对7例局部晚期肺癌患者施行肺切除合并左心房部分切除术,左上肺叶切除3例,同时行肺动脉和支气管袖状成形术2例,左全肺切除1例,右全肺切除2例,右中、下肺叶切除1例,全组均在非体外循环下行部分左心房切除术。结果本组无手术死亡,随访中,2例分别于术后38,26个月死亡,其余5例健在。中位生存期18.4个月。结论非体外循环下扩大性肺切除合并左心房部分切除治疗左心房及心包内肺静脉受侵犯的局部晚期肺癌,提高了患者的生活质量,延长了生存期。

Extended pulmonary and atrial resection for the treatment of locally advanced lung cancer

Objective To explore the efficacy of the extended operation for locally advanced non-small cell lung cancer invading left atrium and intrapericardial pulmonary vein.Methods From June 1998 to November,2004,lobectomy or pneumonectomy combined with extended resection of left atrium were carried out in 7 patients with locally advanced lung cancer.Three left upper lobectomies(two combined bronchoplastic procedures and pulmonary artery sleeve reconstruction),one left pneumonectomy,two right pneumonectomies,one right middle and lower lobectomy were performed.No cardiopulmonary bypass was employed.Results There were no operative mortality in this series.Major complications included one atrial fibrillation and one heart failure.Two patients died during follow-up at 38 and 26 months after surgery respectively.Five patients are alive and diseasefree at 26,22,9,6 and 2 months from surgery respectively.The median survival was 18.4 months.Conclusions Extended resection of combined left atrium and pulmonary for some T_4 lung cancer without cardiopulmonary bypass can improve the quality of life and increase the long term survival.Radically surgery management for selected T_4 lung cancer should be considered.