肺动脉切除重建术在肺癌外科治疗中的应用

目的 总结肺动脉切除重建术在肺癌外科治疗中应用的经验。方法 对36例中心型肺癌侵犯肺动脉的病人行肺动脉切除重建术。重建术采用自体心包移植补片5例、奇静脉移植补片3例、心包管间位移植2例，肺动脉袖式切除9例，侧壁切除17例；同时支气管袖式切除30例，肺叶切除6例。术后辅助放疗14例，化疗12例。结果 术后1例支气管吻合口瘘者死亡，余者肺通气及灌注良好。术后1、3和5年生存率分别为82．9％、48．1％和35．3％。结论 应用自体心包、奇静脉移植及直接肺动脉重建术治疗中心型肺癌是一种安全、有效、可靠的术式，能扩大手术适应证，彻底切除肿瘤，保存肺功能，疗效满意。

Pulnonary artery reconstruction in patients with central type lung cancer

Objective: To review the surgical experience of sleeve resection and prosthetic reconstruction of the pulmonary artery (PA) in the treatment of central type lung cancer. Methods: Between March 1992 and September 1999, 36 patients with lung cancer invading PA were surgically treated. According to pTNM classification, 2 patients were in atage II, 21 in stage IIIa and 3 in stage IIIb . Depending upon the degree of PA involvement, the surgical procedures included 5 PA reconstructions by a patch of autologous pericardium, 3 using a patch of autologous azygous venae and 2 by a pericardial conduit, 9 PA sleeve resections, 17 PA wedge resections. Bronchial sleeve lobectomy or bilobectomy were performed in 30 patients and standard lobectomy in 6. 14 patients received postoperative radiotherapy and 12 chemotherapy. Results: There was 1 postoperative death resulting from bronchial anastomotic leak (2 8%). Roentgenography,flexible bronchoscopy and echocardiography were in normal range in all patients with no bronchial stent stenosis or vascular thrombosis. The overall 1,3 and 5 year survival rates were 82 9%, 48 1% and 35 3%, respectively. Conclusion: The results suggest that PA reconstruction in the patients with central type lung cancer is a safe, and effective surgical technique as alternative to pneumonectomy. This method can ensure more radical resection of lung cancer, maximize preservation of functional pulmonary parenchyma.