心包内处理血管治疗中心型肺癌

目的:与心包外全肺切除疗效对比,探讨心包内处理血管治疗中心型肺癌的临床疗效及价值。方法:1997年3月至2004年3月,对76例中心型肺癌患者进行了全肺切除术,对其中34例无法在心包外行全肺切除的患者,行心包内处理肺、动静脉全肺切除术,占同期全肺切除的44.7%(34/76)。结果:经心包内处理血管的患者无手术死亡,无支气管胸膜瘘发生;切缘癌阳性2例(5.9%),术后出现心慌、气短症状及心律失常6例,发生率18%。术后1年生存率85%,3年生存率32%,5年生存率21%。同期经心包外行全肺切除者,发生支气管胸膜瘘1例,切缘癌阳性2例(4.8%),术后出现心慌、气短症状及心律失常8例,发生率19%。术后1年生存率87%,3年生存率29%,5年生存率20%。结论:与心包外全肺切除相比,心包内处理血管全肺切除术可提高肺癌的切除率,提高患者的生存质量,延长患者的生存时间,手术安全可靠,是外科治疗中心型肺癌的有效手段。

Treatment of central type lung cancer with intrapericardial management of blood vessels pneumonectomy

Objective:To compare the therapeutic effect of intrapericardial pneumonectomy and extrapericardial pneumonectomy. Methods: Hospital records of 76 patients suffering from central type lung cancer who underwent pneumonectomy from March 1997 to March 2004 were analyzed. 34 cases (44.7%) of them were performed intrapericadial management of blood vessels pneumonectomy. Results: Among the 34 patients no death and bronchopleural fistula occurred, 2 of them were found tumor cells marginally, 6 patients occurred postoperative cardiac events. 1-, 3-, 5-year suvival rates were 85%, 32%, 21% respectively. In others underwent extrapericardial pneumonectomy there was one bronchopleural fistula and 8 postoperative cadiac events. Two of them were found tumor cells marginally. 1-, 3-, 5-year suvival rates were 87%, 29%, 20% respectively. Conclusion:Compared with extrapericardial pneumonectomy, intrapericadial management of blood vessels pneumonectomy can improve the resection rate, improve patiens' live quality, extend patiens' live span. It may be an effective treatment of central type lung cancer.