扩大性手术切除侵犯心房、降主动脉和隆凸的非小细胞肺癌  

Extended operation for non-small lung cancer invading left atrium and great vessels and trachea carina

作　　者：罗清泉[1] 周允中[1] 赵晓箐[1] 谭强[1] 

机构地区：[1]上海市胸科医院胸外科,上海200030

出　　处：《中国癌症杂志》2004年第3期262-264,共3页China Oncology

摘　　要：目的 :探讨外科手术切除侵犯心脏、大血管和气管隆凸的局限性晚期非小细胞肺癌的临床疗效和手术适应证。方法 :对侵犯心房 3例、降主动脉 1例、气管隆凸 3例的非小细胞肺癌实施外科切除。术前排除远处和对侧肺转移 ,骨扫描排除全身骨转移。侵犯心房 3例中 ,2例为左全肺切除 ,1例为右全肺切除 ;侵犯降主动脉 1例为左上叶肺癌术后复发并侵犯降主动脉 ,在建立左心房 降主动脉转流辅助下完成降主动脉切除及人工血管置换 ;侵犯隆凸的 3例 ,术前气管镜发现肿瘤距隆凸的距离分别为 1.8,1.0和 0 .3厘米 ,均行右全肺袖形切除和隆凸成形。术后病理均为鳞癌 ,分期T4N0 M0 6例 ,T4N2 M0 1例。结果 :无 1例并发症 ;7例中 6例随访超过 1年 ,1例 (降主动脉切除 )已超过 9月 ;4例随访超过 3年 ;肺静脉内血栓形成中的 1例于术后 2年半即术后 30月因脑转移死亡 ,隆凸切除中的 1例因余肺感染致呼吸衰竭于术后 15月死亡。结论 :对于侵犯心脏、大血管和隆凸的局限性晚期非小细胞肺癌 ,病例选择正确和良好的手术技术确保局部肿瘤的完整性切除 。Purpose:To evaluate the clinical effects and indications of surgical treatment of non small lung cancer invading the left atrium and great vessels and trachea carina. Methods:From August 1998 to Auguest 2003, we performed operations on patients with non-small lung cancer invading the left atrium in 3 cases, invading the descending aorta in 1 case, invading trachea carina in 3 cases; all the patients have been examined to exclude distant metastasis, including nuclear bone scan to exclude bone metastasis; there were 2 cases of left pneumonectomy and one of right pneumonectomy invading the left atrium, there were 3 cases of right sleeve pneumonectomy invading the trachea carina. For the cases invading the descending aorta, we performed the operation with atrium-aorta bypass, Pathology examination: all of the cases were squamous lung cancer, staging of T 4N 0M 0 for 6 cases,T 4N 2M o for 1 case. Results:No complication, follow up: 6 cases survived more than 1 year,1 case survived more than 9 months;4 cases were alive for more than 3 years, 1 case invading the atrium died in 30 months because of brain metastasis,1 case invading the carina died in 15 months because of pulmonary infection. Conclusions:For localized advanced non-small lung cancer invading the aorta and invading the carina and the atrium, if we selected the patient correctly and with a good surgical technique with complete radical resection of the tumor ,we can acquire good results.

关 键 词：手术治疗 心房 大血管 隆凸 非小细胞肺癌 体外循环 

分 类 号：R734.2[医药卫生—肿瘤] R730.56[医药卫生—临床医学]