累及气管下段右侧壁和上腔静脉的右上肺癌的外科治疗  

Surgical management of lung cancer in the right upper lobe involving right side of the lower tra-chea and superior vein cava

作　　者：付圣灵[1] 徐沁孜[1] 付向宁[1] 张霓[1] 孙威[1] 蔡奕欣[1] 艾波[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院胸外科,武汉430030

出　　处：《临床外科杂志》2014年第9期685-687,共3页Journal of Clinical Surgery

摘　　要：目的：探讨累及气管下段右侧壁和上腔静脉的右上肺癌外科治疗策略及其疗效。方法累及气管下段右侧壁和上腔静脉的T4期肺癌外科治疗患者4例，采用“左主支气管延长”法气道重建，2例采用腔外分流法置换上腔静脉，2例行上腔静脉侧壁切除术。1例同时行肺动脉侧壁部分切除术。结果4例患者均顺利完成手术，无围手术期死亡。术后均给予低分子肝素抗凝治疗2周，之后改为阿司匹林抗凝治疗。术后声音嘶哑合并肺部感染1例，1例房颤。无其他严重并发症，术前上腔静脉阻塞综合征的2例患者术后无上腔静脉阻塞表现，胸部增强CT提示上腔静脉通畅。2例患者分别生存34个月和36个月，仍在随访中；另2例术后病理N2的患者分别生存30个月和31个月，已死亡。结论左主支气管根部延长术和腔外分流法上腔静脉置换或侧壁切除用于治疗累及气管下段右侧壁和上腔静脉的右上肺癌，安全有效。Objective To explore the surgical management of lung cancer in the right upper lobe involving the right side of the lower trachea and superior vein cava and its effectiveness.Methods Four patients with lung cancer（T4）involving right side of the lower trachea and superior vein cava received air-way reconstruction with our new technique named elongation of the root of the left main bronchus.Two pa-tients underwent superior vena cava replacement by shunt interposition,and the other two patients under-went partial resection of the superior vena cava.One patient underwent partial resection of the right pulmo-nary artery.Results The procedure was completed successfully in 4 patients.There were no perioperative deaths.Low molecular heparin was applied as anticoagulant for two weeks after surgery,and it was changed to aspirin later.No major complications were observed.Atrial fibrillation occurred in one patients,and post-operative hoarseness and pneumonia occurred in one patient.The superior vena cava syndrome in two pa-tients disappeared after surgery.Two patients died at the 30th and 31th months after operation respective-ly.The other two patients have survived for 34 and 36 months.Conclusion Elongation of the root of the left main bronchus combined with superior vena cava replacement or partial resection is safe and effective in the treatment of lung cancer in the right upper lobe involving right side of the lower trachea and superior vein cava.

关 键 词：肺癌 气管隆突重建 支气管成形 上腔静脉置换 上腔静脉侧壁切除 

分 类 号：R734.2[医药卫生—肿瘤]