肺癌侵犯胸壁的外科治疗  

Surgical Treatment of Lung Cancer with Chest Wall Invasion

作　　者：李之山[1] 汪良骏[1] 方德康[1] 张德超[1] 张汝刚[1] 张大为[1] 

机构地区：[1]中国医学科学院中国协和医科大学肿瘤医院胸外科,100021

出　　处：《实用癌症杂志》2001年第6期628-630,共3页The Practical Journal of Cancer

摘　　要：目的　探讨肺癌侵犯胸壁的手术切除方式及影响患者生存的因素。方法　对 30例侵犯胸壁的肺癌患者的外科治疗结果进行综合分析。结果　全组中肺叶切除 2 6例 ,双肺叶切除 2例 ,全肺切除 2例 ;壁层胸膜外切除 6例 ,胸壁肌肉和肋骨切除 (整块切除 ) 2 4例。根治性切除 2 5例 ,根治切除率 83.3% ( 2 5 /30 )。手术并发症发生率 6 .7% ( 2 /30 ) ,手术死亡率 3.3% ( 1/30 )。鳞癌18例 ,腺鳞癌 8例 ,腺癌 3例 ,大细胞未分化癌 1例。T3 N0 M0 2 0例 ,T3 N1M0 5例 ,T3 N2 M0 5例。采用寿命表法 (lifetable)计算生存率 ,用对数秩和检验 (Logranktest)其显著性。 1、3、5年生存率分别为 40 .2 %、10 .8%和 10 .8%。根治性切除患者 5年生存率为13.2 % ,姑息性切除者中无 5年生存者 (P >0 .0 5 )。根治性切除无淋巴结转移者 5年生存率为 15 .5 % ,有淋巴结转移者中无 5年生存者 (P >0 .0 5 )。不考虑淋巴结转移情况 ,根治性切除患者中 ,肿瘤侵犯胸壁局限于壁层胸膜者的 5年生存率为 15 .0 % ,而侵犯胸壁肌肉和肋骨者中则无 5年生存者 (P >0 .0 5 )。结论　胸膜外切除或胸壁整块切除是外科治疗肺癌侵犯胸壁的主要手段。能否根治切除。Objective To study of surgical approach to lung cancer with chest wall invasion and the factors influencing survival.Methods The clinical materials of 30 surgically treated patients with lung cancer and chest wall invaded were retrospectively analyzed.Life table method was used to calculate the survival rate,its significance was tested by logrank test.Results All patients underwent thoracotomy (lobectomy 26,bilobectomy 2,pneumonectomy 2).Extrapleural resection was performed in 6 patients,en bloc resection of chest wall and lung was performed in 24 patients.25 patients received complete resection (CR).Operative complication occurred in 2 patients.Operative mortality was 3.3%.The 1-,3-and 5-year survival rate was 40.2%,10.8% and 10.8% respectively.The 5-year survival rate of CR patients was 13.2% it was 0,in incomplete resection patients.The 5-year survival rate of CR patients with T_3N_0M_0 disease was 15.5%,it was 0 in patients with T_3N_ 1-2M_0 disease(P>0.05).Independent of lymph node involvement,the 5-year survival rate of patients with the chest wall invasion limited to parietal pleura was 15.0%,it was 0% in patients with tumor invading into the ribs or soft tissues(P>0.05).Conclusion The survival of patients with lung cancer invading the chest wall after resection is dependent on the completeness of resection,the extent of lymph node involvement and the depth of chest wall invasion.

关 键 词：肺肿瘤 胸壁受侵 肺癌 外科手术 手术方式 生存 

分 类 号：R734.2[医药卫生—肿瘤] R730.56[医药卫生—临床医学]