气管袖式全肺切除治疗中央型支气管肺癌  

Tracheal sleeve pneumonectomy for bronchogenic carcinoma invading the carina

作　　者：陈乾坤[1] 姜格宁[1] 丁嘉安[1] 陈昶[1] 陈晓峰[1] 朱余明[1] 汪浩[1] 周晓[1] 高文[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》2012年第3期129-131,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨气管袖式全肺切除治疗支气管肺癌术后并发症和生存预后的影响因素。方法回顾性分析1985年至2010年间48例气管袖式全肺切除的手术方式、手术并发症、病死率和长期生存结果，汇总分析国际主流相关文献的报道结果。结果全组围手术期死亡3例，病死率为6．3％，无术中死亡病例；术后5年总生存率为24．3％；N0、N1和N2患者的5年生存率分别为52％、13％和0（N0对N1P=0．04，N。对N2P=0．003，N1对N2P=0．06）。鳞癌和腺癌的术后5年生存率分别为27．3％和12．5％（P=0．04）。淋巴结转移状况为独立的预后影响因子（P=0．006）。结论只要严格掌握手术指征、加强麻醉和围手术期管理、在有经验的外科医师操作下，气管袖式全肺切除治疗中央型支气管肺癌是安全、有效的术式之一。Objective Bronchogenic carcinoma involving the carina or tracheobronchial angle still presents a challenge due to specific problems related to surgical technique and airway management. Aim of this paper is to examine complications and long-term survival of our personal series and those reported in literature. Methods Between 1985 and 2010, 48 patients underwent carlnal resection： a fight tracheal sleeve pneumonectomy was performed in 47 patients and a left tracheal sleeve pneumonectomy in 1 patient. The anastomosis was performed with aid of high-frequency jet ventilation or introfield tube ventila- tion. Results Overall morbidity and mortality rate was 25 % and 6.3 % respectively, and there was no death in operation. 5-yearsurvival rate of patients with squamous and adenocarcinoma was 27.3% and 12.5% , respectively, P =0.04. The over- all 5-year survival rate was 24.3%. Patients without nodal involvement had a significantly better prognosis than N1 and N2 pa- tients （5-year survival： 52%, 13% and 0, respectively）. Multivariate analysis showed that nodal status was the only inde- pendent prognostic factor（ P = 0. 006 ）. Conclusion With careful selection of patients and meticulous surgical technique, Tracheal sleeve pneumonectomy for bronchogenic carcinoma can be accomplished with acceptable mortality and morbidity, providing good long-term results.

关 键 词：肺肿瘤 肺切除术 隆凸切除 

分 类 号：R734.2[医药卫生—肿瘤]