肺转移瘤的诊断与外科治疗

目的探讨肺转移瘤的诊断、手术指征、切除方式及影响预后的因素，以提高患者的生存率。方法125例肺转移瘤患者均行手术治疗，共行肺转移瘤切除术138次，其中行一次手术116例，二次手术5例，三次手术4例。手术方式为肺部分切除66次，肺段切除2次，肺叶切除53次，肺叶加部分胸壁扩大切除2次，全肺切除3次，肿瘤剜除12次；行开胸手术130次，电视胸腔镜手术（VATS）8次。结果本组患者中原发肿瘤为上皮组织来源的94例，肉瘤类26例，其它种类5例。全组患者无围术期死亡，随访122例，随访时间1～10年，1年、3年和5年生存率分别为90．4％、53．3％和34．8％；其中结、直肠癌、肾癌和软组织肉瘤的预后较好，5年生存率分别为43．8％、37．5％和33．3％。105例肺转移瘤完全切除患者的5年生存率为38．9％，20例不完全切除患者为16．7％。89例行常规肺门及纵隔淋巴结摘除患者仅有12例术后病理证实有淋巴结转移，无淋巴结转移患者和有淋巴结转移患者的5年生存率分别为41．5％和14．3％。结论对诊断明确、符合标准的肺转移瘤患者行积极的手术治疗可取得满意的效果，手术径路以后外侧小切口为主，能否完全切除肿瘤和肺门纵隔淋巴结的转移状况是影响预后的重要因素。

The Diagnosis and Surgical Treatment for Pulmonary Metastases

Objective To investigate the diagnosis, indications for surgery, operative methods and prognostic factors of surgical resection for pulmonary metastases, and improve the survival rate of patients with pulmonary metastases. Methods A total of 125 patients with pulmonary metastases underwent 138 metastasectomies, 116 patients had metastasectomy once while 5 patients underwent a second metastasectomy and 4 patients a third metastasectomy. There were 66 wedge resections, 2 segmentectomies, 53 lohectomies,2 en bloc resections of chest wall plus lobectomy,3 pneumonectomies and 12 precision resections. Surgical approaches included 130 thoracotomies and 8 video assisted thoracic surgery. Results The primary tumor sites were epithelial in 94 patients ,sarcoma in 26 and others in 5. There was no perioperative mortality. A total of 122 patients were followed up , follow-up time was 1-10 years. The 1-, 3-, and 5-year survival rates were 90.4%, 53. 3%, and 34. 8% respectively. Better prognoses were found in patients with colorectal cancer, renal cancer and soft tissue sarcoma, the 5-year survival rates were 43.8%, 37.5%, and 33. 3% respectively. For the 105 patients whose pulmonary metastases were resected completely, the 5-year survival rate was 38.9%. The 5-year survival rate was only 16.7% for 20 patients with incomplete resection, however. Systematic lymph node dissection had been performed in 89 patients hut metastases were identified only in 12 patients. The 5 year survival rates were 14. 3% for node positive patients and 41.5% for node negative patients. Conclusion Surgical resection for pulmonary metastases should be performed in properly selected patients and successful outcomes can be achieved. Posterolateral mini-thoracotomy is the most common surgical approach. The completeness of resection and the status of mediastinal lymph nodes may he important prognostic factors.