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作 者:袁天柱[1] 寿化山[2] 杨鲲鹏[2] 廖文勇[1] 向敏峰[1]
机构地区:[1]广西医科大学第四附属医院胸心外科,广西柳州545005 [2]郑州大学第二附属医院胸外科,河南郑州450014
出 处:《中国医药导报》2009年第18期33-34,共2页China Medical Herald
基 金:柳州市科技局(2008031413);广西壮族自治区卫生厅(E2008379)资助项目
摘 要:目的:探讨微创肌肉非损伤性开胸术(Muscle-Sparing thoracotomy,MST)气道和(或)血管重建治疗中心型非小细胞肺癌(non-small cell lung cancer,NSCLC)的可行性及临床效果。方法:本组共27例,其中,鳞癌14例,腺鳞癌5例,腺癌7例,黏液表皮样癌1例;ⅡB期9例,ⅢA期12例,ⅢB期6例。均采用左或右胸前外侧MST,长9~15cm。主要手术方式包括:右上叶袖状切除7例,其中3例同时行肺动脉袖状切除;右下叶袖状切除2例;左上叶袖状切除9例,其中,4例同时行肺动脉袖状切除术,2例同时行肺动脉楔形切除术;左下叶袖状切除3例;右肺中上叶袖状切除2例;右肺中下叶袖状切除2例;隆凸切除成形2例。结果:MST能充分暴露术野,全部病例没有输血。26例患者为完全性切除(R0),1例为不完全性切除(R1)。术后发生胸腔积液1例,心律失常2例,无支气管胸膜瘘发生,无围术期死亡病例。术后住院天数为9~14d。结论:采用MST对局部晚期NSCLC行气道和(或)血管重建,可取得较满意的临床效果。术中需要采用单手及加长器械操作,必要时采用头灯或冷光源协助照明。Objective: To determine the possibility and clinical efficacy results of MST on airway and/or vascular reconstruction for treating central NSCLC. Methods: 27 cases, including 14 cases with squamous cancer, 5 cases with adenosquamous cancer, 7 cases with adenocarcinoma and 1 case with mucoepidermoid carcinoma, were selected in our study. 9 cases were at stage 11 B, 12 cases were at stage m A and 6 cases were at stage HI B. All patients received left or right lateral thoracic MST with 9-15 cm. The main procedures included right upper lobe sleeve-like resection (n=7), with pulmonary sleeve-like resection at the same time (n=3); right lower lobe sleeve-like resection (n=2); left upper lobe sleeve-like resection (n=9), with pul- monary sleeve-like resection at the same time (n=4), and pulmonary wedge resection at the same time (n=2). Left lower lobe sleeve-like resection (n=3); right lung mid upper lobe sleeve-like resection (n=2); right lung mid lower lob sleeve-like resec- tion (n=2); and protuberance resection and plastic surgery (n=2). Results: MST could fully expose operation field, and no patient received blood transfusion. Among 27 cases, 26 cases were complete resection (Ro) and 1 case was incomplete resection (R1). Postoperative complications included pleural effusion (n=l) and arrhythmia (n=2). No bronchopleural fistula or perioperative death occurred. Postoperative hospitalization was 9-14 d. Conclusion: Proper airway and/or vascular reconstruction treating local late NSCLC is consistent with surgery principle for lung cancer by MST, which can achieve good clinical results. Good preparation before operation and careful management of airway, bronchovascular reconstruction during and after operation is the key to success.
关 键 词:微创肌肉非损伤性开胸术 非小细胞肺癌:肺切除术 气道重建 血管重建
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