微创肌肉非损伤性开胸术治疗支气管肺癌的中期随访  

The midterm follow-up of Muscle-Sparing thoracotomy for lung cancer

作　　者：周贤[1] 陈海泉[1] 周建华[1] 孙艺华[1] 罗晓阳[1] 

机构地区：[1]上海交通大学附属上海市第六人民医院心胸外科,上海200233

出　　处：《中国癌症杂志》2006年第8期635-637,共3页China Oncology

摘　　要：背景与目的：肺癌的外科治疗已发生了巨大的变化。微创肌肉非损伤性开胸术对肺叶切除手术是安全、切实可行的，现已成为国外治疗肺癌的主要手段。但目前国内尚未见关于其与预后的相关报道。本研究主要探讨微创肌肉非损伤性手术（Muscle—Sparing）治疗支气管肺癌的手术安全性、彻底性及临床有效性。方法：2001年至今随访超过1年的150例行Muscle—Sparing手术的支气管肺癌病例，其中男性113例，女性37例，平均年龄64．61岁。病理类型：鳞癌63例，腺癌66例，小细胞癌9例，腺鳞癌6例，大细胞癌3例，粘液表皮样癌1例，肉瘤样癌1例，神经内分泌癌1例。病理分期：ⅠA期18例，ⅠB期54例，ⅡA期4例，ⅡB期17例，ⅢA期46例，ⅢB期7例，Ⅳ期4例。手术方式：右侧肺叶切除者76例，右全肺切除者10例，左侧肺叶切除者52例，左全肺切除者12例。术中行肺门及纵隔淋巴结清扫，平均清扫淋巴结6．6组（包括第2组至第11组）。这150例患者随访了12～58个月，平均随访18．6个月。结果：术后支气管切缘阳性者12例，手术后需输血者5例，有4例患者出现乳糜胸，3例发生皮下积液。围术期死亡率为1．3％。术后1年总的生存率为78％，术后3年总的生存率为62％。结论：微创肌肉非损伤性开胸术与传统的胸部后外侧切口开胸手术比较，具有一定优势。微创肌肉非损伤性开胸术操作简单，手术视野充分，几乎可以完成所有的肺癌切除手术，可以作为肺癌手术的常规术式。而且微创肌肉非损伤性开胸术的中期随访结果是令人满意的。Background and purpose： Surgical treatment of lung cancer has developed enormously. Muscle-Sparing thoracotomy which is both feasible and safe for lobectomy has been the main choices for treatment of lung cancer in the Western countries. However, there is short age of reports about the survival rate of the muscle-sparing thoractomy for lung cancer in China. We studied the operative safety and clinical effectiveness of Muscle-Sparing operation for lung cancer and the midterm survival rate of the patients of lung cancer after muscle-sparing thoractomy. Methods： 150 patients have received Muscle-Sparing operation in our hospital and the follow-up time was more than one year so far, it included 113 males and 37 females with a mean age of 64.61 years. All patients had pathologically proof with 63 cases of squamous carcinoma, 66 of adenocarcinoma, 9of small cell carcinoma and 3 of large cell carcinoma, pTNM distributions were as follows： type Ⅰ A in 18 cases, type Ⅰ B in54 cases, type ⅡA in4 cases, type ⅡB in 17 cases, type ⅢA in45 cases, type ⅢA in8 cases and type Ⅳ in 4 cases. In terms of surgical approach, there were 76 cases of right pulmonary lobectomy, 10 cases of right pneumonectomy, 52 cases of left pulmonary lobectomy, 12 cases of left pneumonectomy. Lymph nodes in hilum of lung and mediastinum were disected. Results： There were 12 patients with positive margin in bronchus stump after surgery. Only five cases requested blood transfusion during operation. There occured chylothorax in 4 cases, subcutaneous fluidify in 3 cases. The 30-day mortality was 1.3%. The 1- and 3- year survival rates were 78% and 62%, respectively. Conclusions： Muscle-sparing thoracotomy is superior to standard postero-lateral thoracotomy to some extent. Muscle-sparing thoracotomy is simple and safe, providing adequate exposure, satisfying radical resection. So it could be the routine incision in resection of carcinoma and benign tumors in lung. Furthermore the result of the midterm follow-up after muscle-sparing

关 键 词：肺癌 手术治疗 微创手术 

分 类 号：R734.2[医药卫生—肿瘤]