Rendina E A, Venuta F, De Giacomo T, Ciccone A M, Moretti M, Ruvolo G, Coloni G F
Department of Thoracic Surgery La Sapienza University of Rome, Italy.
Ann Thorac Surg. 1999 Sep;68(3):995-1001; discussion 1001-2. doi: 10.1016/s0003-4975(99)00738-9.
Lobectomy associated with reconstruction of the pulmonary artery (PA) is a technically feasible alternative to pneumonectomy in patients with lung cancer. However, concern about postoperative complications and long-term survival limited its acceptance so far.
Between 1989 and 1996, we performed a PA reconstruction in 52 patients (41 men, 11 women; age range 35 to 75 years, mean 60 years) with lung cancer. Eleven patients had induction chemotherapy. We performed 15 PA sleeve resections, 34 PA reconstructions by a pericardial patch, and three PA reconstructions by a pericardial conduit, associated with a bronchial sleeve lobectomy or bilobectomy (33), or with standard lobectomy (19). Immediate and long-term postoperative evaluation included spirometry, echocardiography, perfusion lung scans, computed tomography, and PA angiography. The follow-up ranged between 27 and 96 months and is complete for all patients.
We had one specific postoperative complication (PA thrombosis) and no mortality. Perfusion scans and PA angiography were normal in all but the 1 patient having thrombosis. Mean forced expiratory volume (FEV) in 1 s and forced vital capacity (FVC) were, respectively, 72% and 80% preoperatively, 65% and 76% 1 month after surgery, and then they plateaued at 70% and 78% after 6 months. Echocardiography showed patterns in the normal range and normal estimates of PA pressures in all but 2 patients. Five-year survival was 38.3% for the entire group, 18.6% for stages IIIA and B, and 64.4% for stages I and II.
Morbidity, mortality, and functional data do not differ from what is currently reported for standard lobectomy. Long-term survival is in line with that reported for standard resection. These data support PA reconstruction as a viable option in the treatment of lung cancer.
对于肺癌患者，肺叶切除联合肺动脉（PA）重建在技术上是全肺切除的可行替代方案。然而，对术后并发症和长期生存的担忧限制了其目前的应用。
1989年至1996年期间，我们对52例（41例男性，11例女性；年龄范围35至75岁，平均60岁）肺癌患者进行了PA重建。11例患者接受了诱导化疗。我们进行了15例PA袖状切除术、34例心包补片PA重建术和3例心包管道PA重建术，分别联合支气管袖状肺叶切除术或双叶切除术（33例），或标准肺叶切除术（19例）。术后即刻和长期评估包括肺功能测定、超声心动图、肺灌注扫描、计算机断层扫描和PA血管造影。随访时间为27至96个月，所有患者均完成随访。
我们有1例特定的术后并发症（PA血栓形成），无死亡病例。除1例发生血栓形成的患者外，所有患者的灌注扫描和PA血管造影均正常。术前第1秒用力呼气量（FEV）和用力肺活量（FVC）的平均值分别为72%和80%，术后1个月分别为65%和76%，6个月后稳定在70%和78%。除2例患者外，超声心动图显示模式在正常范围内，PA压力估计正常。整个组的5年生存率为38.3%，ⅢA期和ⅢB期为18.6%，Ⅰ期和Ⅱ期为64.4%。
发病率、死亡率和功能数据与目前标准肺叶切除术的报告结果无差异。长期生存率与标准切除术的报告结果一致。这些数据支持PA重建作为肺癌治疗的可行选择。
