局限性胸膜肺切除术治疗伴癌性胸水非小细胞肺癌的远期结果  

Long-term Results of Treating Patients with Non-small Cell Lung Cancer Associated with Cancerous Pleural Effusion by Limited Pleuro-Pneumonectomy

作　　者：张国良[1] 刘军[1] 赵东勇[2] 姜冠潮[1] 彭洁[1] 沈晨阳[1] 李梦赞[1] 马超[1] 

机构地区：[1]北京大学人民医院胸外科,北京100044 [2]廊坊市人民医院胸外科,河北廊坊102800

出　　处：《中国胸心血管外科临床杂志》2002年第1期17-19,共3页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的　评估局限性胸膜肺切除术治疗伴癌性胸水非小细胞肺癌的远期效果和应用价值。　方法　对1994年 1月至 1998年 12月间采用该术式治疗的 16例伴癌性胸水肺癌患者进行定期随访 ,了解患者生活质量、复发情况和生存时间。计算术后中位数复发和中位数生存时间。　结果　本组无手术死亡 ,无严重手术并发症。术后胸闷、呼吸困难、胸腹壁疼痛症状明显缓解 ,恶病质迅速消失 ,未见胸水复发 ,但后期均发生远处脏器转移。术后肿瘤复发距手术时间 3～ 36个月 ,中位数复发时间 12个月。随访至 2 0 0 0年 8月 ,所有病例死亡 ,存活期 7～ 39个月。存活 1年以上 15例 ,1年生存率 94% ;存活 18个月以上 13例 ,生存率 81% ;存活 2年以上 7例 ,生存率 44 % ;存活 3年以上 2例 ,生存率 13% ;中位数生存期 2 1.5个月。　结论　此术式控制胸水、缓解症状效果肯定。术后晚期均发生远处脏器转移 ,但其中位数生存期明显长于仅做姑息性肺内癌灶切除或内科治疗患者 ,且长于全胸膜肺切除术。Objective To evaluate the long term results and effectiveness of treating patients with non small cell lung cancer associated with cancerous pleural effusion by limited pleuro pneumonectomy. Methods Sixteen cases underwent limited pleuro pneumonectomy from January 1994 to December 1998. All the patients were followed up at regular intervals. The patient's living quality, the condition of tumor recurrence and survival time were inquired. Then, a median period of recurrence and survival was reckoned. Results There were no mortality and no significant postoperative complication. Postoperatively, chest distress, dyspnea and pain of chest or abdomen were relieved. Cachexia disappeared rapidly. No pleural effusion recurrence was seen. But in the late stage, metastases of carcinoma happened to the distant organs in all patients. The period of recurrence or metastasis after operation was 3-36 months. A median time of recurrence was 12 months. Follow up to August 2000,all the patients died and the survival period was 7-39 months. The 1 year survival rate was 94%(15 patients), the 18 month survival rate 81%(13 patients), the 2 year survival rate 44%(7 patients), the 3 year survival rate 13%(2 patients). Median overall survival time was 21.5 months. Conclusion The major advantages of this procedure were relief of symptoms and control of pleural effusion dramatically. Although the metastasis of carcinoma occurred in the distant organs, the median survival time of this group postoperatively was much longer than that of palliative segmental resection or medical therapy, and was not shorter than pleuro pneumonectomy. Limited pleuro pneumonectomy is an effective treatment of cancerous pleural effusion following lung cancer and can be used widely.

关 键 词：肺癌 癌性胸腔积液 肺切除术 

分 类 号：R734.2[医药卫生—肿瘤]