肺切除加左心房部分切除术治疗局部晚期肺癌

目的 为寻求晚期肺癌患者的外科治疗方法，提高手术疗效，总结34例局部晚期肺癌患者行肺切除加左心房部分切除术的经验。方法 对34例局部晚期肺癌患者施行了肺切除加左心房部分切除术。左肺下叶切除术19例，左全肺切除术4例，右肺中下叶切除术6例，右肺下叶切除术2例，右全肺切除术3例。肿瘤侵及肺静脉根部与心房交界处近心端25例，明显侵犯左心房9例，其中2例同时侵及靠近肺动脉分叉处，常规无法处理肺动脉，在体外循环下切除全肺并同时切除部分左心房。结果 本组无手术死亡，术后发生并发症11例，其中心律失常8例次，肺炎5例次，心功能不全1例次。1年、3年生存率分别为79．4％、44.1％，6例生存＞5年。结论 肺癌累及左心房或肺静脉根部时应切除部分左心房以达到根治性切除，从而延长患者寿命，提高生存质量。

Lobectomy or pneumonectomy combined with resection of part of the left atrium in the treatment of locally advanced lung cancer

Objective To seek the surgical method for locally advanced lung cancer so as to improve the therapeutic effect. Clinical experience of resection of part of the left atrium in the treatment of 34 patients with this kind of diseases was summarized. Methods Lobectomy or pneumonectomy combined with resection of part of the left atrium were carried out in 34 patients with locally advanced lung cancer. The operations included left lower lobectomy in 19 cases, left pneumonectomy in 4 cases, right middle and low lobectomy in 6 cases, right lower lobectomy in 2 cases and right pneumonectomy in 3 cases respectively.The base of the pulmonary vein were invaded by the tumor in 25 patients, while the left atriums were invaded obviously in 9 patients. Two patients were operated using extracorporeal circulation because of main pulmonary artery and the left atrium being invaded. Results There were no operative mortality in this series, 11 patients had operative complication,including arrhythmia in 8 cases , pneumonia in 5 cases and heart failure in 1 case .The 1, 3-year survival rates were 79.4%, 44.1% respectively. Six patients had survived 5 years. Conclusion Resection of part of the left atrium for lung cancer invading the left atrium or the base of the pulmonary vein can remarkably increase the long-term survival and improve the prognosis in patients with locally advanced lung cancer if the invasion is limited and the resection is complete.