Lausberg H F, Graeter T P, Wendler O, Demertzis S, Ukena D, Schäfers H J
Department of Thoracic and Cardiovascular Surgery, University Hospitals Homburg, Homburg/Saar, Germany.
Ann Thorac Surg. 2000 Aug;70(2):367-71; discussion 371-2. doi: 10.1016/s0003-4975(00)01725-2.
To improve postoperative pulmonary reserve, we have employed parenchyma-sparing resections for central lung tumors irrespective of pulmonary function. The results of lobectomy, pneumonectomy, and sleeve resection were analyzed retrospectively.
From October 1995 to June 1999, 422 typical lung resections were performed for lung cancer. Of these, 301 were lobectomies (group I), 81 were sleeve resections (group II), and 40 were pneumonectomies (group III).
Operative mortality was 2% in group I, 1.2% in group II, and 7.5% in group III (group I and II vs. group III, p<0.03). Mean time of intubation was 1.0+/-4.1 days in group I, 0.9+/-1.3 days in group II, and 3.6+/-11.2 days in group III (groups I and II vs. group III, p<0.01). The incidence of bronchial complications was 1.3% in group I, none in group II, and 7.5% in group III (group I and II vs group III, p<0.001). After 2 years, survival was 64% in group I, 61.9% in group II, and 56.1% in group III (p = NS). Freedom from local disease recurrence was 92.1% in group I, 95.7% in group II, and 90.9% in group III after 2 years (p = NS).
Sleeve resection is a useful surgical option for the treatment of central lung tumors, thus avoiding pneumonectomy with its associated risks. Morbidity, early mortality, long-term survival, and recurrence of disease after sleeve resection are similar to those seen after lobectomy.
为改善术后肺储备功能，我们对中央型肺肿瘤采用了保留实质的切除术，而不考虑肺功能情况。对肺叶切除术、全肺切除术和袖状切除术的结果进行了回顾性分析。
1995年10月至1999年6月，对422例典型肺癌患者实施了肺切除术。其中，301例为肺叶切除术（I组），81例为袖状切除术（II组），40例为全肺切除术（III组）。
I组手术死亡率为2%，II组为1.2%，III组为7.5%（I组和II组与III组比较，p<0.03）。I组平均插管时间为1.0±4.1天，II组为0.9±1.3天，III组为3.6±11.2天（I组和II组与III组比较，p<0.01）。I组支气管并发症发生率为1.3%，II组无并发症，III组为7.5%（I组和II组与III组比较，p<0.001）。2年后，I组生存率为64%，II组为61.9%，III组为56.1%（p =无统计学意义）。2年后，I组局部疾病无复发生存率为92.1%，II组为95.7%，III组为90.9%（p =无统计学意义）。
袖状切除术是治疗中央型肺肿瘤的一种有用的手术选择，从而避免了全肺切除术及其相关风险。袖状切除术后的发病率、早期死亡率、长期生存率和疾病复发情况与肺叶切除术后相似。
