侵犯胸壁非小细胞肺癌外科治疗

目的探讨侵犯胸壁非小细胞肺癌（NSCLC）手术方法及预后。方法回顾分析1984-2004年手术治疗的侵犯胸壁的NSCLC 127例。T3N0M0 72例，T3N4M0 33例，T3N2M0 17例，T4N0M0 3例，T4N1M0 2例；鳞癌66例，腺癌59例，大细胞癌2例。肺单叶切除78例，两叶切除7例，全肺切除33例，楔形切除或段切9例，胸壁整块切除46例．胸壁不连续切除13例，胸膜外切除68例。结果全组无手术死亡病例。11例术后出现并发症。5年生存率在完全切除及不完全切除的患者分别为25％及8％（P〈0．05）。在完全切除的病例中，淋巴结转移情况（P〈0．05）、浸润深度（P〈0．05）具有独立估计预后的价值。结论侵犯胸壁的NSCLC的生存率与切除是否完全、淋巴转移情况及肿瘤侵犯胸壁的深度有关。

Surgical Treatment for Non- small Cell Lung Cancer Invading Chest Wall

Objective To explore surgical methods for non-small cell lung cancer(NSCLC)invading chest wall and prognostic factors.Methods 127 patients who were operated on for NSCLC invading chest wall in our hospital between 1984 and 2004,were reviewed retrospectively.72 cases were T_3N_0M_0,33 cases were T_3N_1M_0,17 cases were T_3N_2M_0,3 cases were T_4N_0M_0,2 cases were T_4N_1M_0;66 cases were with squamous cell cancer, 59 with adenocarcinoma and 2 with large cell carcinoma.Operation procedure were 78 lobectomies,7 bilobectomies, 33 pneumonectomies, 9 wedge resections or segment resections.En bloc resection were in 46 cases,discontinuous resection of the chest wall were in 13 cases,and extrapleural resection were in 68 cases.Results There was no operative mortality.Operative complications occurred in 11 cases.The 5-year survival rate was 25% and 8% after complete and incomplete resection,respectively(P<0.05).In completely resected patients,nodal involvement(P<0.05)and depth of chest wall invasion(P<0.05) were independent prognostic factors.Conclusion Survival of patients with lung cancer invading chest wall was related to completeness of resection,nodal involvement and depth of invasion.