肺癌肺叶袖状切除术的安全性和有效性  

Security and Efficacy of Sleeve Lobectomy for Lung Cancer

作　　者：黄邵洪[1] 谷力加[1] 翁毅敏[1] 冯卫能[1] 程超[1] 钟文昭[1] 

机构地区：[1]中山大学附属第三医院胸心外科,广州市510630

出　　处：《中国肿瘤临床》2005年第5期278-281,共4页Chinese Journal of Clinical Oncology

摘　　要：目的:评价肺癌肺叶袖状切除术后患者的手术安全性和远期生存状况。方法:回顾分析了1999年10月至2003年12月行肺癌根治术的94名病例,其中肺叶袖状切除术11例(Ⅰ组),全肺切除术17例(Ⅱ组),肺叶切除术66例(Ⅲ组)。通过比较三组术后气管插管时间、ICU停留时间、吻合口并发症率及围手术期死亡率,评价肺叶袖状切除术的手术安全性,比较Ⅰ、组间的生存期和转移复发率探讨其远期有效性。组间率比较用χ2检验或FisherⅡ精确检验,均数比较用t检验,生存分析用K aplan-M eier法,生存曲线比较用Log rank检验。显著性差异标准α=0.05。结果:Ⅰ、Ⅱ、Ⅲ组的手术死亡率为0,11.8%,3.0%,组间无显著性差异;平均气管插管时间为0.5±2.3天,2.0±7.2天,0.6±4.1天(Ⅰ、ⅢVSⅡ组,P<0.05);吻合口并发症率为3.0%,0,5.8%,组间无显著性差异。Ⅰ组1年、3年生存率为45.5%、32.5%,组为58.8%、Ⅱ45.8%。两组生存率、远期局部复发率和转移率无显著性差异。结论:肺癌肺叶袖状切除术具有和肺叶切除术相近的手术安全性,优于全肺切除术,而其复发转移率、远期疗效与后者相近,是安全有效的手术方式。Objective: To evaluate the operative security and long term survival after sleeve lobectomy for lung cancer. Methods: Between October, 1999 to December 2003, 94 patients underwent radical resecton of lung cancer were retrospectively analyzed, including 11 sleeve lobectomies (group Ⅰ), 17 pneumonectomies (group Ⅱ) and 66 lobectomies (group Ⅲ). The intubation time, ICU care duration, anastomotic complications and operative mortality between groups were compared to evaluate the operative security for sleeve lobectomy. The survival and recurrence between group Ⅰ and Ⅱ were compared to assess its long term efficacy. The χ2 or fisher's precision test was used for comparision of rates, t-test for means, Kaplan-Meier method and Log rank test for suvival analysis. The criteria for the significant difference α=0.05. Results: Operative mortality was 0,11.8%,3.0% (Ⅰ,Ⅱ,Ⅲ) for each group without significant difference. Mean intubation time(days) was 0.5±2.3, 2.0±7.2, 0.6±4.1 respectively (Ⅰ, ⅢVSⅡ组, P<0.05). Anastomotic complication rate was 3.0%, 0, 5.8% without significant difference. The 1-year and 3-year survival was 45.5% and 32.5% for group Ⅰ, 58.8% and 45.8% for group Ⅱ. There was no significant difference between groups for the survial, recurrence or metastasis rates. Conclusion: Sleeve lobectomy is a safe, efficacious surgical option for lung cancer, with better operative safety compared to pneumonectomy. Its recurrence, metastasis or long term survival are all comparable to the cases of lobectomy.

关 键 词：肺癌 支气管成形术 生存状况 

分 类 号：R734.2[医药卫生—肿瘤]