右肺中叶肺癌诊断与外科治疗  

Diagnosis and Surgical Treatment of Middle Lobe Carcinoma of Lung in 26 Cases.

作　　者：胡润磊[1] 李浒[1] 章希贤[1] 王国卿[1] 

机构地区：[1]杭州市第一人民医院胸外科,310006

出　　处：《医学研究杂志》2008年第1期70-71,共2页Journal of Medical Research

摘　　要：目的探讨原发性中叶肺癌的临床特点,探索中叶肺癌的合理治疗。方法回顾性分析了7年间外科治疗的26例中叶肺癌的临床资料。结果本组无围手术期死亡,PTNM分期:Ⅰ期4例,Ⅱ期7例,ⅢA期10例,ⅢB期4例,Ⅳ期1例。单纯中叶切除8例,中下叶切除12例,中上叶切除5例,剖胸探查1例。共清扫肺门和纵隔淋巴结共62组,101枚,平均每例清扫2.4组。病理结果,鳞癌8例,腺癌12例,腺鳞癌4例,复合型肺癌(腺癌伴大细胞肺癌以及腺癌伴肺泡细胞癌各1例)2例,阳性淋巴结53/101,其中PN18例,PN211例,区域纵隔淋巴结转移8例,跨区域纵隔淋巴结转移3例。16例患者术后辅以综合治疗,随访1年、3年、5年生存率分别为80.8%、50.0%、11.5%。未经综合治疗的患者1年、3年、5年生存率分别为61.5%、23.0%、7.6%。两组患者3年生存率比较差异有显著性(χ2检验,P<0.05)。结论中叶肺癌容易误诊;中叶肺癌容易发生纵隔淋巴结转移,还可以引起跨区域转移,应注意跨区域淋巴结的清扫;由于中叶支气管的解剖特点,中央型肺癌容易跨叶侵犯,必须行双叶切除,以减少局部复发。术后应常规辅以综合治疗。Objective To discuss the surgical treatment of middle lobe carcinoma of lung, explore the rational thrapy of middle lobe carcinoma of lung. Methods Retrospective analysis 26 clinical data of middle lobe carcinoma of lung and underwent surgical treatment in our hospital from 1995 to 2002,17 cases are male,9 cases are female, the average age is 53.6 years. Results There were no operative death, Acording to UICC staging system, there were 4 cases in stage Ⅰ ,7 cases in stage Ⅱ , 10 cases in stage Ⅲ A,4 cases in stage ⅢB and 1 cases in stage Ⅳ. Twenty -five radical resection with 8 cases lobectomies, 17 cases bilobectomies,one cases under went exploratory thoracotomy. 62 groups of hilar and mediastinal lymph nodes were disected,. All cases were diagnosed by pathology include 8 cases of spuamous cell carcinoma, 12 of adenocarcinoma, 4 of adenosquamous carcinoma, lof alveolar cell carcinoma and 1 of complex carcinoma respectively. Metastatic frequency of thoracic lymph nodes was 52.4% （53/101） ,in which N1 was 7.9% （8/101）, N2 was 10.9% （11/ 101 ） ,region lymph nodes metastatisis were comfimed in 8 cases and stride region lymph nodes metastatisis in 3 cases, the 1 - ,3 - and 5 -year survival rates were 80.8% ,50.0% and 11.5% in group （16 patients） who were treated by chemotherapy alone or chemotherapy plus radiotherapy ,and 61.5% ,23.0% and 7.6% in simple operation group. The 3 - year survival rate in the postoperation chemotherapy alone or chemotherapy plus radiotherapy group exceeded the simple group（χ^2 test,P 〈 0.05）. Conclusions The clinical symptom of middle lobe carcinoma of lung isn＇ t typical, diagnosis are not easy; Metastatic frequency of hilar and mediastinal lymph nodes is high, spanningregion lymph nodes disection should be applied. Because of bronchus in the middle lobe anatomy characteristic, central type of middle lobe carcinoma of lung easy to extend across interlobar. To cut down the part relapse bilobectomies should be perfoemed. It is important to give postoperat

关 键 词：肺癌 手术治疗 右肺中叶 诊断 

分 类 号：R734.2[医药卫生—肿瘤]