肝癌术后孤立性肺转移灶切除术的临床应用  

Clinical Application of Isolated Pulmonary Metastasectomy for Primary Hepatocellular Carcinoma Postoperative

作　　者：祝明华[1] 江寅芳[2] 杨运海[3] 

机构地区：[1]杭州师范大学附属医院胸心外科,310015 [2]杭州市第一人民医院肿瘤科 [3]浙江大学附属第一医院胸心外科

出　　处：《医学研究杂志》2013年第5期117-119,共3页Journal of Medical Research

基　　金：浙江省医药卫生平台基金资助项目(2012ZDA014)

摘　　要：目的探讨原发性肝癌根治术后肺转移灶的治疗方案选择。方法回顾性分析2006年9月1日～2010年8月31日原发性肝癌根治术后肺转移癌患者的治疗方案。43例患者分为胸腔镜下行肺部肿块楔形切除术(实验组,18例)、胸腔镜下行肺叶切除+纵隔淋巴结清扫术(A对照组,16例)、系统化疗为主而未做手术(B对照组,9例)。结果实验组与A对照组在第1次肺部手术后第1、2、5年总体生存率无显著性差异(P>0.05);实验组、A对照组分别与B对照组在肺部肿块确诊后第1、2、5年总体生存率有显著性差异(P<0.05);实验组与A对照组在第1次行肺部手术时的手术时长、术中出血量、日均胸管引流量比较有非常显著性差异(P<0.01),与胸管放置天数和平均住院日比较有显著性差异(P<0.05)。结论胸腔镜下肺楔形切除术治疗原发性肝癌根治术后孤立性肺转移癌既可减少并发症,又能提高远期生存率。Objective To explore the treatment of pulmonary metastasis from primary hepatocellular carcinoma after radical hepatic resection. Methods To retrospectively analyze the treatment of 43 patients who had pulmonary metastasis from primary hepatocellular carcinoma after radical hepatic resection from Sep. 1st, 2006 to Aug. 31st, 2010. Forty three patients were divided into three groups. Treatment group（ 18 cases） adopted videoassisted thoracoscope （VATS） lung mass wedge resection; The control group A （16 cases） adopted VATS lobectomy combined with diaphragmatic lymph node dissections; The control group B （9 cases） was given to chemotherapy without surgery. Results The 1 - , 2 - , and 5 - year overall survival rates of the treatment group and A control group after initial thoracotomy have no significant difference （P 〉 0.05） ; The treatment group and control group A were compared with control group B, the overall survival rates after pulmonary metastatic carcinoma were diagnosed in the 1 st, 2nd, 5th years have significant difference （P 〈 0.05）. In the first lung surgery, the treatment group compared with the control group A, the operative time, intraoperative amount of bleeding and aver- age daily amount of postoperative thoracic drainage have a very significant difference（P 〈0.01 ）. Chest cavity drainage tube placed days and the average days in hospital have significant difference（P 〈 0.05）. Conclusion Pulmonary wedge resection under VATS for isolated pulmonary metastasis from primary hepatocellular carcinoma postoperative could reduce the complications, and could also improve the long -term survival rate.

关 键 词：原发性肝细胞癌 肺转移癌 外科手术 胸腔镜 

分 类 号：R735.3[医药卫生—肿瘤]