隆突切除重建术手术的要点  

Clinical Experience of the Carinal resection

作　　者：钱成[1] 徐正浪[1] 王群[1] 郑如恒[1] 谭黎杰[1] 蒋伟[1] 

机构地区：[1]复旦大学附属中山医院胸外科,上海200032

出　　处：《中国临床医学》2008年第2期174-175,共2页Chinese Journal of Clinical Medicine

摘　　要：目的：探讨降低隆突切除重建术手术并发症和死亡率的方法。方法：1994年-2007年8月共行隆突切除重建术13例，其中男性10例，女性3例；年龄35～77岁，平均为54．1岁，均为恶性肿瘤，气管隆突部肿瘤4例，气管下段肿瘤累及隆突1例，中心型肺癌侵及隆突8例。隆突全肺切除5例（右3例，左2例），隆突加右侧上叶切除3例，单纯隆突切除4例，右侧半隆突切除1例。结果：本组13例无术中死亡。1例并发肺部感染予呼吸机辅助通气治疗后死亡，2例术后并发成人呼吸窘迫综合征（ARDS）予呼吸机辅助通气治疗，其中1例死亡。围手术期死亡2例，病死率为15．4％（2／13）。随访1个月～5年，1例失访，术后1年内死亡1例，术后3年内死亡2例，术后5年内死亡3例，1、3、5年生存率分别为88．9％（8／9）、66．7％（4／6）和40．0％（2／5）。结论：气管隆突切除重建手术创伤大、难度高，并发症发生率及死亡率高。而正确掌握适应证，手术操作精细，术后积极防治并发症是提高手术成功率的重要措施。Objeclive：To explore the mode to reduce the morbidity and mortality of carinal resection. Methods： From 1994 to Auguest 2007, 13 earinal resection were performed at our department on patients with carinal tumor or branchogenic cancer invading carina. The operation style of the group includes 5 cases of sleeve pneumoneetomy plus earinal resection, 4 cases of sleeve resection of the right upper lobe plus carinal resection, 4 cases of carinal resection, 1 case of semi-carinal resection. Results：There was no death during operation. One case died of severe pulmonary infection after treated with mechanical ventilation, and two cases developed adult respiratory distress syndrom （ARDS）, one of whom died though mechanical ventilation was given. The mortality was 15.4%. The survial rate at 1, 3, 5 years were 88.9%（8/9）, 66.7%（4/6） and 40.0%（2/5）, respectively. Conclusion：Accurate selection of patients, a meticulous adherence lo surgical precision, and optimal postoperative patient care have become mandatory to reduce the morbidity and mortality of this operation.

关 键 词：气管隆突切除重建术 死亡率 

分 类 号：R655[医药卫生—外科学]