双袖式肺叶切除治疗局部晚期非小细胞肺癌

目的:总结31例肺动脉支气管双袖式肺叶切除手术的临床经验,探讨其手术适应证、手术技巧以及术后处理。方法:1996年1月-2006年12月共完成肺动脉支气管双袖式肺叶切除手术31例,其中男性24例,女性7例;年龄43～75岁,平均62岁;鳞癌24例,腺癌3例,腺鳞癌4例。病变位于左侧30例,右侧1例。行支气管肺动脉袖式左上肺叶切除术26例,支气管袖式、肺动脉部分成形左上肺叶切除术4例,支气管肺动脉袖式右上肺叶切除术1例,通过回顾病史总结临床经验。结果:术后多数患者出现排痰不畅,需行纤维支气管镜吸痰。术后发生各种并发症4例,发生率12.9%(4/31),其中肺炎3例、肺不张1例。术后死亡1例,病死率3%(1/31)。结论:支气管肺动脉双袖式肺叶切除术使某些病程较晚、年龄偏高、心肺功能低下的患者获得手术机会,扩大了肺癌的手术适应证,延长生存期,提高了患者的生活质量,但应严格掌握手术适应证、熟练手术操作及术前术后处理。

Bronchial and Pulmonary Artery Sleeve Lobectomy in the Treatment of Local Advanced Non-small-cell Lung Cancer

Objective:To investigate the indication,surgical experience and peri-operative treatment of bronchial and pulmonary artery sleeve lobectomy.Methods::The clihicel data of 31 patients who had been underwent bronchial and pulmonary artery sleeve lobectomy for non-small-cell lung cancer(NSCLC)from January,1996 to December,2006 were analysed retrospectively.Among them were 24 men and 7 were women with a mean age of 62 years(range,43-75 years).The histologic type was predominantly squamous cell carcinoma(n=24),adenocarcinoma(n=3)and adeno-squamous carcinoma(n=4).The surgery procedure included bronchial and pulmonary artery sleeve left upper lobectomy in 26 cases,sleeve left lobectomy and wedge resection of the pulmonary artery in 4 cases and right upper lobectomy in 1 case.Results::There was 1 operative death;the operative complication rate was 12.9% and the morbidity rate was 3%.Most patient need to use fibrile bronchscope because of sputum,a total of 4 patients presented with pulmonary complications:3 pneumonias and 1 atelectasis.Conclusion:The results suggest that bronchial and pulmonary artery sleeve lobectomy in the treatment of local advanced NSCLC is a safe and effective technique.Bronchial and pulmonary artery sleeve lobectomy can ensure radical resection of lung cancer and maximal preservation of pulmonary function,it expands the indication of lung cancer.