59例30岁以下原发性肺癌的临床及病理  

Surgical results and prognosis of patients with primary bronchogenic carcinoma aged less than 30 years

作　　者：段亮[1] 陈晓峰[1] 张惠君[1] 谢东[1] 姜格宁[1] 

机构地区：[1]同济大学附属上海市肺科医院胸外科,200433

出　　处：《中华胸心血管外科杂志》2011年第4期208-211,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨30岁以下青少年原发性肺癌的特殊临床和病理特点。方法外科治疗年龄8～29岁，平均23岁的原发肺癌病人59例。术前有症状者49例，其中18例术前被误诊。根治性手术46例，姑息性手术3例，剖胸探查术7例，胸腔镜下活检术3例。术后病理腺癌18例，类癌13例，黏液表皮样癌9例，鳞癌5例，小细胞癌4例，腺鳞癌3例，其他4例。TNM分期：Ⅰa期8例，Ⅰb期3例，Ⅱa期9例，Ⅱb期12例，Ⅲa期15例，Ⅲb期8例，Ⅳ期4例。结果术后并发肺不张3例，发生率5．08％，剖胸探查组术后并发呼吸衰竭死亡1例。全组5年生存率为27．O％，其中根治组为35．0％。单因素分析显示不同p-TNM分期和手术方式与其生存率高度相关（P〈0．05），性别、病理类型和术后化疗均不是预后的影响因素（P〉0．05），Ⅰ期、Ⅱ期、Ⅲa期、Ⅱb期＋Ⅳ期5年生存率分别为75．0％、33．3％、14．3％和0．0％。叶切、全切和探查术5年生存率分别为43．0％、18．2％和0．0％。多因素分析显示仅TNM（19=0．000）是影响青少年原发性肺癌术后的独立影响因素。结论青少年肺癌应引起重视，提高确诊率，避免当作肺部良性疾病而耽误手术时机。青少年肺癌根治性手术治疗5年生存率为35％，与普通肺癌人群相当，应积极采取以手术为主的综合治疗。Objective To investigate and analyze the clinical and pathological features of surgical treatment for primary bronchogenic carcinoma in adolescent patients. Methods A retrospective review is presented of patients less than 30 years with surgical treatment of bronchogenic carcinoma between 1969 and 2008. There were59 patients （36 male and 23 female）. Mean age was 23 years（ range 8 - 29 ）. The ratio of men to women patients was 1.7： 1. Forty-nine cases （83.0%） were symptomatic at presentation and 18 cases（ 30.5% ）were misdiagnosed as other diseases. Surgical procedures included radical resection in 46 cases, palliative resection in 3 cases, thoracotomy only for unreseetable disease in 7 cases and VATS biopsy in 3 cases. The histological types were 18 adenocarcinomas, 13 carcinoids, 9 mucoepidermoid carcinoma, 5 squamous cell carcimomas, 4 small cell lung cancer, 3 adenosquamous carcinoma and 4 others. On TNM staging, 8 cases in stage Ⅰa, 3 cases in stage Ⅰ b, 9 cases in stage Ⅱa, 12 cases in stage Ⅱb, 15 cases in stage ma, 8 eases in stage Ⅲb, 4 cases in stageⅣ. Resuits There were no operative death in radical group. Post-operative atelectasis in 3 cases. One case died from postoperative respiratory failure in explosive group, the postoperative five year survival rate was 27.0%. radical resection group 5-year survival was 35%. Univariate analysis identified TNM stage and surgical procedures as predictors of survival（ P 〈 0.05 ）. factors that had no significant effect on overall survival included gender, histologic sbutype and postoperative chemotherapy （ P 〉 0.05）. The 5 year survival in stage Ⅰ, Ⅱ, Ⅲa, Ⅲb＋ Ⅳ were 75.0% ,33.3%, 14.3% and 0, respectively. The 5 year survival in lobectomy, pneumonectomy and exporsive were 43.0%, 18.2% and 0, respectively. On multivariate analysis, TNM stage of disease was the only independent predictor of survival （ P = 0. 000）. Conclusion We should pay attention to adolescent lung cancer and improve the diagnosis rate avoidin

关 键 词：青少年 肺癌 手术治疗 

分 类 号：R734.2[医药卫生—肿瘤]