肺动脉重建在肺癌切除术中的应用

１９９３年７月～１９９７年５月间，在１７例肺癌患者手术中进行了肺动脉切除和重建。肺动脉袖状切除１２例，侧壁切除５例。同时作总支气管袖状切除１０例，楔形切除２例，残端成形１例，上叶支气管移位吻合２例。１例双袖状右上中联合肺叶切除后，又切断下肺静脉。下叶肺置于肝素溶液中（１２５００Ｕ／５００ｍｌＮＳ），１５ｍｉｎ后将下肺静脉移植于上叶静脉残端，再作支气管、肺动脉吻合。随访１～４４个月，无手术近期死亡。术后１３个月死于心肺衰竭１例，１２、１７、１８、１９个月各有１例死于肿瘤复发，余１２例生存良好，最长存活４４个月。作者认为当肿瘤或（及）肿大淋巴结环绕肺动脉或其分支起始部时，则应行肺动脉切除和重建，其必要性和可行性均在术中确定。双袖状右上中肺联合肺叶切除术中，当总支气管或肺动脉切除过长时可将下肺静脉移植于上肺静脉残端以缓解吻合口张力，作者主张围手术期应行抗凝治疗。

Reconstruction of Pulmonary Artery during Resection of Lung Cancer

From July 1993 to May 1997, reconstruction of pulmonary artery (PA)was performed in 17 cases of lung cancer resection.The procedure consisted of sleeve operation in 12, lateral wall reconstruction in 5,concomitant bronchial sleeve resection 10, wedge resection 2, bronchoplasty 1, translocated anastomosis of upper bronchus 2. In one of these cases, double sleeve right upper and mid lobectomy were performed. After the inferior pulmonary vein was cut, the detached right lower lobe was immersed in Heparin solution (12500U/500ml NS) for 15 minutes,and then the inferior pulmonary vein was replanted to the superior pulmonary vein; the bronchus and artery were anastomosed likewise. All the patients were followed up for 1 44 months, no operative death occurred. There was one case died of cardiac failure 13 months postoperatively. Four patients died of cancer recurrence at 12, 17,18,19 months after operation. The remaining 12 patients survived well and the longest survival was 44 months. The authors conclude that PA sleeve reconstruction is the choice when PA was encircled by tumor or metastatic lymph nodes. The necessity of resection can be decided during the course of operation.The double sleeve lobectomy with replant of pulmonary vein is an option technically in selected patients provided anticoagulation therapy has been given perioperatively.