出 处:《中国肺癌杂志》2018年第1期24-31,共8页Chinese Journal of Lung Cancer
基 金:中日友好医院青年科技英才计划项目(No.2014-QNYC-B-09)资助~~
摘 要:背景与目的非小细胞肺癌合并左房瘤栓病例在局部晚期肺癌中占有一定比例,积极外科手术能否带来获益,以及具体术式选择均存在争议,是目前外科研究的热点。我们报告了单中心接受手术治疗的非小细胞肺癌合并左房瘤栓病例队列,结合预后分析探究合理的诊疗方法。方法自2006年8月-2017年7月共有11例非小细胞肺癌合并左房瘤栓病例在中日友好医院胸外科确诊并行手术治疗,对其临床资料、治疗选择、病理类型、预后情况进行了回顾性研究。结果 11例患者中,男性7例,女性4例,平均年龄57.9岁,6例患者接受术前新辅助放化疗。全部患者手术过程顺利,其中行正中开胸体外循环下手术3例,体外膜肺氧合辅助下后外侧切口入路手术1例,常规后外侧切口入路手术6例,胸腔镜辅助小切口入路手术1例。手术达R0切除9例,R1切除2例。手术用时210min-380 min,平均292 min,出血量100 mL-1,600 mL,平均436 mL。全组有1例(9.1%)术后90天内死亡病例,另有4例(36.4%)出现心律失常、脑梗、低氧血症等围术期并发症。术后病理诊断鳞癌6例,腺癌4例,肉瘤样癌1例,病理分期p T4N0M0 7例,p T4N1M0 4例。术后对9例患者行辅助化疗,随访期内对2例患者行放射治疗。全组随访时间2个月-53个月,3年无病生存率30.7%,中位无病生存期31个月,3年总体生存率49.1%,中位总体生存期为33个月。结论对有选择的非小细胞肺癌合并左房瘤栓患者,选择合理术式切除肿瘤病灶和肺静脉、左房内瘤栓,加强围术期管理并配合新辅助/辅助化放疗,可能获得满意的预后。Background and objective Non-small cell lung cancer with left atrial tumor thrombus accounts for a small proportion of local advanced lung cancer. Whether surgery could bring benefits, as well as surgical options are still controversial, and have always been hot spots in surgical research. We report a single center experience of surgical treatment to non-small cell lung cancer with left atrial tumor thrombus, aim to figure out more reasonable treatment strategy. MethodsFrom August 2006 to July 2017, a total of 11 cases of non-small cell lung cancer with left atrial tumor thrombus underwent surgery in Thoracic Surgery Department of China-Japan Friendship Hospital. Clinical data, treatment options, pathological types and prognosis of these patients were collected to perform a retrospective study. Results Of the 11 patients(mean age of 57.9), 7 were men and 4 were women. Six of them received neoadjuvant radiotherapy and/or chemotherapy. All patients underwent smooth operation, including 3 cases with cardiopulmonary bypass, 1 case of posterolateral approach under extracorporeal membrane oxygenation, 6 cases of conventional posterolateral approach and 1 case of video-assisted minithoracotomy. Nine patients were evaluated as R0 resection while 2 cases were evaluated as R1 resection. The Surgeries cost an average of 292 min(210 min-380 min), with an average of 436 mL(100 mL-1,600 mL) blood loss. One patient(9.1%) died within 90 days after surgery, and another 4 cases(36.4%) suffered postoperative complications such as arrhythmia, cerebral infarction or hypoxemia. Six cases of squamous cell carcinoma, 4 cases of adenocarcinoma and 1 case of sarcomatoid carcinoma were identified by pathology. Seven cases were staged as p T4 N0 M0 while 4 cases were staged as p T4 N1 M0. Nine patients underwent adjuvant chemotherapy, and two patients underwent radiotherapy during follow-up. The overall follow-up time was 2 to 53 months, the 3-year disease-free survival rate was 30.7%, the median disease-free survival ti
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