Chhajed Prashant N, Eberhardt Ralf, Dienemann Hendrik, Azzola Andrea, Brutsche Martin H, Tamm Michael, Herth Felix J F
Pulmonary Medicine, University Hospital Basel, Switzerland.
Ann Thorac Surg. 2006 May;81(5):1839-43. doi: 10.1016/j.athoracsur.2005.11.054.
Therapeutic bronchoscopy is used for endobronchial staging of lung cancer and symptomatic relief of central airway obstruction or postobstructive pneumonia. The aim of this study was to assess the utility of therapeutic bronchoscopy as a complementary tool in the combined bronchoscopic and surgical management of malignant airway lesions before curative lung surgery.
Seventy-four consecutive patients with nonsmall cell lung carcinoma undergoing a therapeutic bronchoscopy procedure followed by surgery with a curative intent were included.
A single interventional bronchoscopic method was used in 27 patients (36%) and a combination of methods in 47 patients (64%). Median forced expiratory volume in 1 second (FEV1) before and after bronchoscopy were 1.7 L and 2.2 L, respectively, and forced vital capacity (FVC) was 2.5 L and 3.3 L, respectively. Sleeve upper lobectomy was performed in 22 patients (30%), sleeve upper bilobectomy in 16 patients (22%), lower bilobectomy in 2 patients (3%), pneumonectomy with sleeve resection in 2 patients (3%), and pneumonectomy in 28 patients (38%). The following surgeries were performed in 1 patient each: sleeve middle lobectomy, sleeve lower lobectomy, carina resection and complex reconstruction, and exploratory thoracotomy. Overall, parenchyma-sparing surgery (lobectomy or bilobectomy) could be performed in 57% patients after therapeutic bronchoscopy. There were no in-hospital deaths or deaths in the first 30 days after surgery.
Therapeutic bronchoscopy can be used as a complementary tool in the combined bronchoscopic and surgical management of malignant airway obstruction before curative lung surgery. Therapeutic bronchoscopy might permit parenchyma-sparing surgery in patients with lung cancer.
治疗性支气管镜检查用于肺癌的支气管内分期以及缓解中央气道阻塞或阻塞后肺炎的症状。本研究的目的是评估治疗性支气管镜检查作为一种辅助工具在根治性肺手术前对恶性气道病变进行支气管镜和手术联合治疗中的作用。
纳入74例连续接受治疗性支气管镜检查并随后进行根治性手术的非小细胞肺癌患者。
27例患者（36%）采用了单一的介入性支气管镜检查方法，47例患者（64%）采用了联合方法。支气管镜检查前后第1秒用力呼气量（FEV1）的中位数分别为1.7L和2.2L，用力肺活量（FVC）分别为2.5L和3.3L。22例患者（30%）进行了袖式上叶切除术，16例患者（22%）进行了袖式上叶双叶切除术，2例患者（3%）进行了下叶双叶切除术，2例患者（3%）进行了袖式切除的全肺切除术，28例患者（38%）进行了全肺切除术。以下手术各有1例患者进行：袖式中叶切除术、袖式下叶切除术、隆突切除及复杂重建术和开胸探查术。总体而言，治疗性支气管镜检查后57%的患者可进行保留实质组织的手术（肺叶切除术或双叶切除术）。术后无院内死亡或术后30天内死亡病例。
治疗性支气管镜检查可作为根治性肺手术前对恶性气道阻塞进行支气管镜和手术联合治疗的辅助工具。治疗性支气管镜检查可能使肺癌患者能够接受保留实质组织的手术。
