Chen Peng-Cheng, Zhou Xing-Ming, Chen Qi-Xun, Liu Jin-Shi, Yan Fu-Lai, Jiang You-Hua
Department of Thoracic Surgery,Zhejiang Cancer Hospital, Hangzhou, Zhejiang, 310022, People's Republic of China. chenpengcheng73@yahoo .com.cn
Ai Zheng. 2008 May;27(5):510-5.
BACKGROUND & OBJECTIVE: Bronchial sleeve resection and/or pulmovascular sleeve resection can maximize preservation of normal lung tissues after tumor resection, which provides a resection mode for lung cancer surgery. This study was to investigate the technique, operative results and survival of lung cancer patients after sleeve resection.
Eighty-two central lung cancer patients underwent sleeve resection in Zhejiang Cancer Hospital from Jun. 2001 to Dec. 2006. Among them, 23 underwent concomitant pulmovascular sleeve resection, 2 underwent pulmovascular sleeve resection alone. All patients received systematic lymph node dissection. The results of lymph node dissection and the occurrence of postoperative complications were studied. The survival of patients was analyzed by Kaplan-Meier method.
An average of 20 lymph nodes (range, 9-57; median, 19 ) were dissected from 82 patients. Of the 82 patients, 49 (59.8%) were at stage N1, 21 (25.6%) at stage N2. Two (2.4%) patients died 2 and 3 days after operation. No bronchial anastomotic leakage occurred. The 1-, 2-, 3-, and 5-year survival rates were 78.4%, 52.5%, 39.1%, and 23.4%, respectively, with a median survival of 26 months. There were no significant differences in 1-, 3-, and 5-year survival rates between male and female patients, or between the patients aged of <60 and > or =60. The differences in 1-, 3-, and 5-year survival rates among N1(-) N2(-), N1 (+) N2(-), N2(+) patients, and among stageI, II, IIIA, IIIB patients were significant (P<0.01).
Perioperative mortality and the incidence of anastomosis-related complications for lung cancer patients after sleeve resection are low. Sleeve resection is an alternative to pneumonectomy for certain indications. Systematic lymph node dissection does not increase operative complications and mortality. The survival of lung cancer patients after sleeve resection is conelated to lymph node metastasis and clinical stage, but has no correlation to gender or age.
支气管袖状切除术和/或肺血管袖状切除术能够在肿瘤切除后最大程度地保留正常肺组织，为肺癌手术提供了一种切除方式。本研究旨在探讨肺癌患者行袖状切除术后的技术、手术效果及生存情况。
2001年6月至2006年12月期间，82例中心型肺癌患者在浙江省肿瘤医院接受了袖状切除术。其中，23例同时行肺血管袖状切除术，2例仅行肺血管袖状切除术。所有患者均接受了系统性淋巴结清扫。研究淋巴结清扫结果及术后并发症的发生情况。采用Kaplan-Meier法分析患者的生存情况。
82例患者平均清扫淋巴结20枚（范围9 - 57枚；中位数19枚）。82例患者中，49例（59.8%）为N1期，21例（25.6%）为N2期。2例（2.4%）患者分别于术后2天和3天死亡。未发生支气管吻合口漏。1年、2年、3年和5年生存率分别为78.4%、52.5%、39.1%和23.4%，中位生存期为26个月。男性和女性患者之间，以及年龄＜60岁和≥60岁患者之间的1年、3年和5年生存率无显著差异。N1(-)N2(-)、N1(+)N2(-)、N2(+)患者之间，以及Ⅰ期、Ⅱ期、ⅢA期、ⅢB期患者之间的1年、3年和5年生存率差异有统计学意义（P＜0.01）。
肺癌患者行袖状切除术后围手术期死亡率及吻合口相关并发症发生率较低。对于某些适应证，袖状切除术是肺叶切除术的一种替代选择。系统性淋巴结清扫不会增加手术并发症及死亡率。肺癌患者行袖状切除术后的生存情况与淋巴结转移及临床分期相关，但与性别和年龄无关。
