隆突切除重建术的临床应用27例报道

目的:总结隆凸切除重建术治疗隆突、主支气管肿瘤及中心型支气管肺癌的经验,探讨合理的手术方法及治疗措施。方法:27例患者行单纯隆突切除重建4例,右肺上叶切除及隆突切除重建19例,右全肺切除及隆突切除重建2例,左肺上叶切除及隆突切除重建1例,左全肺切除及隆突切除重建1例。结果:全组病例无围手术期死亡,无支气管吻合口瘘。常见并发症为心律失常、肺部感染、肺不张和呼吸功能不全。隆突、主支气管肿瘤患者术后无瘤生存2~11年。支气管肺癌患者术后3年生存率68.8%,5年生存率36.4%,有1例生存>10年。结论:通过合理的麻醉插管方法,正确的气管吻合技术,良好的术后呼吸道管理,气管隆凸切除重建术可以取得满意的疗效。

Clinical experience of carinal resection and reconstruction:a report of 27 cases

OBJECTIVE:To summanize the experience of carinal resection and reconstruction in the treatment of carinal and stem bronchial tumor and central bronchogenic carcinoma, and approach the proper operative technique and therapeutic measures.METHODS:Twenty-seven patients underwent surgery including carinal resection and reconstruction in 4 cases, right sleeve upper lobectomy plus carinal resection and reconstruction in 19,right pneumonectomy plus carinal resection and reconstruction in 5, left sleeve upper lobectomy plus carinal resection and reconstruction in 1,left pneumonectomy plus carinal resection and reconstruction in 1.RESULTS:There were no death during the perioperative period and no fistula of bronchial anastomosis. The common complications were cardiac dysrhythmia, pneumonia, atelectasis and impaired pulmonary function. The patients with carinal and stem bronchial tumor lived free of tumor for 2 to 11 years after operation. The 3-and 5-year survival rates in patients with central bronchogenic carcinoma were 68.8% and 36.4%, respectively. One patient has survived more than 10 years.CONCLUSION:The carinal resection and reconstruction can be performed with excellent results by using effective anaesthetic methods, appropriate anastomotic technique, and proper postoperative management.