肺癌胸膜全肺切除手术技术探讨  

An Analysis of Surgical Skills in Pleuro-pneumonectomy of Lung Cancer with Malignant Pleural Effusion

作　　者：汪栋[1] 叶玉坤[1] 张传生[1] 韩开宝[1] 周源[1] 孙宏志[1] 孙向东[1] 路东明[1] 许罡[1] 

机构地区：[1]解放军第81医院全军肿瘤中心,江苏南京210002

出　　处：《中国肿瘤》2006年第6期390-392,共3页China Cancer

摘　　要：[目的]探讨肺癌伴胸膜转移恶性胸水行胸膜全肺切除术手术技术和术中处理体会。[方法]1988年1月至2003年1月对21例肺癌伴胸膜转移恶性胸水患者行胸膜全肺切除术。肺部原发病灶位于左肺8例,右肺13例。其中鳞癌1例,腺癌12例,腺鳞癌2例,肺泡细胞癌6例。采用胸膜外径路整块切除病变,低能混切电刀分离壁层胸膜,尤其注重心包、纵隔大血管表面胸膜、膈胸膜的切除;对确无法彻底切除的少量残余癌灶,局部反复电刀烧灼;心包表面有转移病灶未行心包切除者常规行心包开窗;关胸前以大量蒸馏水反复冲洗胸腔及切口,氮芥留置胸腔。[结果]无围手术期死亡,无支气管胸膜瘘、脓胸、大出血等严重并发症。随访已死亡16例,生存期为5￣34个月,其余5例患者随访24￣29个月仍生存,全组中位生存时间18个月,死亡原因均为远处转移,无局部肿瘤复发。[结论]Ⅲb期肺癌病人有选择地行胸膜全肺切除术是安全可行的,改良手术技术可以减少手术并发症、降低肿瘤局部复发机会,采用该术式再结合综合治疗,能获得明显延长生存时间的良好效果。[Purpose] To evaluate the surgical skills in pleuro-pneumonectomy of lung cancer with effusion and the effect of the operation. [Methods] From Jan.1988 to Jan.2003, 21 patients of primary lung cancer with dissemination and malignant pleural effusion were treated chiefly by operation. The surgical procedures included left pleuro-pneumonectomy in 8 patients and right pleuro-pneumonectomy in 13 patients. The operative skills include plural dissection en bloc, management of big vessel in hilar, paying attention to disposal of dissemination on pericardium, big vessels and diaphragm, etc. [Results] All patients recovered postoperatively. There were no severe surgical complications such as bronchopleural fistula, empyema and hemorrhage. Follow-up showed that 16 patients have died at 5 to 34 months after the operation. Other patients were still alive at 24 to 29 months. Mid-lifetime was 18 months. [Conclusions] Pleuro-pneumonectomy selectively performed in lung cancer with malignant pleural effusion （Ⅲb） is safe and manipulatable. Improvement of the surgical skills may reduce the perioperative complications, decrease recurrence of the tumor and so gain a better result.

关 键 词：肺肿瘤 恶性胸水 胸膜全肺切除 手术技术 

分 类 号：R734.2[医药卫生—肿瘤]