自体心包奇静脉补片肺动脉重建术在中心型肺癌治疗中的应用  

Reconstruction of pulmonary artery by autologous pericardium or azygous venae for non-small cell lung cancer

作　　者：刘学刚[1] 施超[1] 刘戈[1] 王祖义[1] 唐震[1] 刘以尧[1] 李小军[1] 

机构地区：[1]蚌埠医学院附属医院胸心外科,安徽233004

出　　处：《中华胸心血管外科杂志》2011年第1期20-23,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：本课题受安徽省卫生厅医学科学研究基金（2002A034）和教育厅自然科学基金（KJ2008853ZC）资助

摘　　要：目的 探讨自体心包、奇静脉移植补片肺动脉重建技术在中心型非小细胞肺癌治疗中应用的临床价值及其外科技术问题.方法 1992年3月至2009年8月,应用自体心包、奇静脉移植补片肺动脉重建技术治疗62例肺血管受侵犯的中心型非小细胞肺癌.术前行新辅助化疗2个疗程17例,术后pTNM分期：Ⅱb期4例,Ⅲa期46例,Ⅲb期12例.根据肺动脉和支气管受侵的情况,采用自体奇静脉移植补片术18例、心包移植补片术38例、制成心包管间位移植术6例,合并上腔静脉侧壁切除心包奇静脉补片成形术5例,同时行支气管袖式切除51例,肺叶切除11例.术后接受辅助化疗47例,辅助放疗19例.结果 全组术中冰冻和术后病理检查证实肺动脉及支气管切缘均无癌残留.手术死亡2例（3.2%）,死因为术后支气管吻合口瘘致呼吸衰竭和术后严重心律失常、心脏骤停各1例.术后主要并发症发生率17.7%（11/62例）,经对症处理后治愈.出院前或术后2～6个月经胸部X线、CT、心脏超声及气管镜检查显示2例发生支气管吻合口狭窄,经气管镜微波治疗好转,其余肺通气及血流灌注良好,无肺血管狭窄和栓塞等并发症.60例术后随访6～210个月,平均49.5个月.术后1、3、5、10年生存率分别80.2%（49/60例）、44.7%（21/47例）、31.4%（11/35例）、23.1%（3/13例）.结论 自体心包、奇静脉移植补片肺动脉重建技术,可安全、有效地用于治疗肺动脉侧壁切除后缺损较大的中心型肺癌病人;制成心包管间位移植对袖式切除后肺动脉缺损过长吻合困难或失败者,是可行的肺动脉重建技术.Objective To review the clinical experience of reconstruction of pulmonary artery（PA） by a pateh of autologus pericardium or azygous venae for non-small cell lung cancer. Methods Between March 1992 and August 2009, 62 patients with locally advanced central lung cancer received sleeve resection and reconstruction of PA. According to PTNM classification, 4 patients were in stage Ⅱb, 46 in stage Ⅲa and 12 in stage Ⅲb. 17 patients had induction chemothoerapy. Sleeve lotrate the PA, the surgical procedures included partial PA tangential resections and reconstructions by a pateh of autologous azygous venas in 18 cases , a patch of autologous pericardium in 38 cases and a complete PA sleeve resection reconstructios by a custom-made autologous pericardial conduit interposition in 6 cases. Partial superior vena cava tangential resctions and reconstructions were performed in 5 patients by a patch of autologous pericardium or azygous venae. 47 patients received pstoperative chemotherapy and 19 had radiotherapy. Results There was 2 early postoperative deaths（3.2%）. The cause of death was bronchial anastomotic leak led to respiratory failure in 1 case and severe arrhmia led to heart arrest in 1. No cancerous tissue of all resection margins are checked by frzen section histology and examination of resection specimens in the surgical pathology laboratory. The postoperative complications occurred in 11 patients（17.7%） and all of them recovered uneventfully.Roentgenography, flexible bronchoscopy and echocardiography were in normal range in the remaining 60 patients with no bronchial anastomosis stenosis or vascular thombosis before discharge and at 2-6 months after surgery. The mean follow up time was 49.5 months （6-210 months）. The overall 1, 3, 5 and 10 yerr survival rates were 80.2%, 44.7% ,31.4% and 23. 1%, respectively. Conclusion Reonstruction of PA by autologous pericardial patch or autologous azygos vein patch is a safe and effective technique for locally advanced lung cancer.For extended circumferen

关 键 词：肺动脉 心包 组织移植 移植 自体 肺肿瘤 

分 类 号：R734.2[医药卫生—肿瘤]