全肺切除治疗晚期肺癌420例临床分析

目的：探讨全肺切除在晚期肺癌治疗中的意义、临床疗效和长期生存率。方法：回顾性分析我院胸外科在过去二十年间实施全肺切除的420例病例。结果：全组420例全肺切除，占同期肺癌手术总量的19.0％（420／2216）。手术分两组即全肺切除＋纵隔淋巴结摘除术（简称前十年组）182例，全肺切除＋纵隔淋巴结清扫术（简称后十年组）238例。全组术后401例手术病人痊愈，围手术期死亡19例（4.5％）。术后并行辅助化疗196例，未作辅助化疗（单纯手术）205例。术后总的并发症发生率为24.8％，全组术后总的1、3、5年生存率为83.8％、51.7％、33.8％。前十年组和后十年组5年生存率差异明显为26.9％vs40.8％（P〈0.003）。术后辅助化疗组与单纯手术组长期生存差异显著为42.3％vs25.4％（P〈0.05）。结论：通过本组420例全肺切除的临床体会我们认为合理的手术适应证的甄选，良好的手术中外科操作处理，实施彻底的纵隔淋巴结规范清扫，完善的术后围手术期管理，术后恰当的综合治疗，可获得较好的临床疗效和长期生存率。全肺切除术在晚期肺癌临床治疗中仍占有较重要的地位。

Clinical experience of 420 cases with advanced lung cancer treated with pneumonectomy

Objectlve：To explore the clinical value,effect and long -term survival rate of the pneulnonectomy in late stage lung cancer. Methods：The 420 cases treated by pneulnonectomy with the advanced cancer were analysed retrospectively in the past 20 years. Results：There were two operation groups in 420 cases,182 cases was lnade by the pnemnoneetomy and lnediastinal lymph node silnple excision（the forlner ten years group） ,238 cases was lnade by the pnemnoneetomy and the total lnedlasfinal lylnph node dissection（the latter ten years group）. After pnemnoneetolny of 196 cases were practiced by the adjuvant ehelnotherapy. The other of 205 cases were only operated. The 401 cases were colnpletely recovered. The perioperation mortality rate was 4.5% ,The incidence of complication in postoperation was 24.8%. 1,3,5 - years survival rates were 83.8% ,51.7% and 33.8% respectively. The 5 years survival rate was 26.9% in the former ten years group and 40.8% in the latter ten years group respectively（P 〈 0. 0003）. And there was significant difference in the postoperation adjuvant ehelnotherapy versus only operation（42.3% vs 25.4% ,P 〈 0.05）. Conclusion： Pneulnoneetolny clinical experience we think that the pneulnoneetolny era1 achieve better effect and long - term survival from selecting reasonably operation indication, handling finely interoperation drilling practice, making thoroughly the systelnatie mediastinal lylnph node dissection, taking perfectly perioperation management and giving suitably postoperational adjuvant ehelnotherapy. The pneulnonectolny plays still an ilnportant position in the late lung cancer.