心房或大血管部分切除在局部晚期肺癌手术中的应用

目的探讨肺叶或全肺切除合并左心房或大血管部分切除治疗局部晚期肺癌的价值。方法回顾性总结我科在2005年2月-2008年9月间，采用部分心房或大血管切除治疗26例局部晚期肺癌（T4N0-N2M0）病例。左全肺及左心房部分切除12例，左全肺及肺动脉干部分切除2例，右全肺及左心房部分切除9例，（其中2例在体外循环辅助下进行），右肺中下叶及部分左心房切除1例，右上肺叶及上腔静脉部分切除人工血管置换2例。结果本组26例患者，无手术死亡病例，术后仅有3例发生心律失常，占11．54％（3／26）。1年生存率为77．8％（14／18），2年生存率为55．6％（5／9）。术后病理分型：鳞癌23例，腺癌1例，大细胞癌2例，T4N0M0者3例，T4N1M0者7例，T4N2M0者16例。结论侵及心房或大血管的局部晚期肺癌（Ⅲb期）采用扩大切除术能提高根治性手术切除率，改善患者生活质量，提高局部晚期肺癌生存率，在临床上有应用价值。

The utilization of the left atrium or large blood vessel partial resection in local advanced lung cancer

Objective To analyze the value of lobectomy or pneumonectomy combined with intraperieardial vascular management or partial resection of the left atrium in treatment of local advanced lung cancer. Methods 26 patients with local advanced lung cancer （stage Ⅲb T4N0-N2M0） underwent lobectomy or pneumonectomy combined with intrapericardial vascular management or partial resection of left atrium, from February 2005 to September 2008. Of 26, 12 with left pneumonectomy combined with partial resection of left atrium; 2 pneumonectomy and partial resection of pulmonary artery trunk; 9 with right pneumonectomy and partial resection of the left atrium; 1 with middle and lower lobectomies and partial resection of the left atrium; 2 with right upper lobectomy and partial resection of superior vena cava, replacement of artificial blood vessel. Results Operation was successful in 26 cases. The rate of 1-year survival is 77.8% （14/18）, the rate of 2-year survival is 55.6% （5/9）. Pathological results：23 cases with squamous cell carcinoma; 1 with adenocarcinoma; 2 with large cell Carcinoma. In TNM staging, 3 with T4N0M0. 7 with T4N1M0 and 16 with T4N2M0. Conclusion Pneumonectomy via intra- pericardial vascular management or combined with partial resection of left atrium in the treatment of local advanced lung cancer can en-hance the possibility of radical resection, remarkably increase the long term survival and improve the life quality of the patients. Therefore, it is clinically valuable.