肺癌切除术后支气管切端阳性病例疗效分析

目的:探讨肺癌术后支气管切缘癌残留的相关形成因素,确立避免和减少切缘癌发生的策略和方法。方法:分析1975～2001年经手术治疗的675例肺癌,在不同肿瘤分期、病理类型、手术适应证与扩大的手术适应证、术前纤维支气管镜所见、不同手术方式、支气管残端不同缝合方法及术中是否行残端快速冷冻病理检查等诸因素,对术后支气管残端癌残留形成的影响。结果:在675例中手术后出现残端癌残留42例,残端癌发生率6.2%,42例中术前纤维支气管镜检查,在支气管腔内观察到肿瘤34例为中心型肺癌,占80.9%,术前支气管镜检查阴性8例为周围型肺癌,占18.1%,支气管残端癌发生率在中心型肺癌比周围型肺癌高(P<0.05);在肺叶切除术中通过冷冻病理检查发现支气管残端阳性12例,术式改变为支气管袖状肺叶切除术。结论:严格掌握肺癌手术的适应证并选择合理术式,术中支气管残端快速冷冻病理检查应作为肺癌外科的手术常规。

Analysis of the related factors about microscopic residual carcinoma at the resection margin in the lung cancer

Objective:To evaluate the related factors about microscopic residual disease at the resection margin in the lung cancer and to determine the method to avoid and decrease the incidence of microscopic residual tumor.Methods:A total of 675 patients underwent lung resection for lung cancer at the upper lobe from 1975 to 2001.The clinical data were reviewed retrospectively.The related factors of microscopic residual disease at the bronchial resection margin,including staging,histology,indications,the preoperative diagnosis by bronchoscope,operation,bronchial stump close methods and intraoperative frozen-section examinations were analyzed.Results:Microscopic residual disease at the bronchial resection margin was found in 28.6% of the patients(12/42).34 cases were diagnosed as central type and 8 cases as peripheral type by preoperative bronchoscopic examination.The incidence of microscopic residual carcinoma was higher in central type than in peripheral type(80.9% VS 18.1%,P<0.05).12 cases received sleeve resection because microscopic residual disease was found by intraoperative frozen-section analysis.Conclusion:Operation indications should be right and the correct operation type should be selected.Intraoperative frozen-section analasis of bronchial stump should be as a routine examination.