Yang Yulun, Zhao Wenzeng
Department of Thoracocardiac Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Zhongguo Fei Ai Za Zhi. 2010 Nov;13(11):1046-9. doi: 10.3779/j.issn.1009-3419.2010.11.09.
Patients suffering from lung cancer often have poor quality of life after pneumonectomy. It has clinical significances to preserve maximum lobes of the "healthy" lung. The aim of this study is to report the applications of lung replantation in treatment of superior lobe central lung cancer.
Three lung cancer cases were included and analysed. The bronchus and margin of lower lung lobe were encroached by cancer. Pulmonary artery was invaded and surrounded by metastatic lymph node. Complete pneumonectomy, antegrade perfusion and retroperfusion with low-potassium dextran (LPD) solution in vitro were performed. The retainable lower pulmonary lobe was selected from the isolated lung and superior pulmonary vein was replaced with inferior pulmonary veins. The bronchus and pulmonary artery were inosculated by turns.
The operative cumulative time ranged from 220 min to 250 min. The isolated time of lobus inferior pulmonary ranged from 120 min to 150 min. The chest tube was pulled out after chest X-ray confirmed the reimplant lung full re-expansion. The patients were followed up for 4 months to 8 months and accomplished adjuvant chemotherapy for 3 or 4 periodicities. The patients had a sound quality of life.
Lung replantation removing the extensive tumor tissue and retaining the maximum pulmonary normal tissue is an useful method for treatment of lung cancer.
肺癌患者肺切除术后生活质量往往较差。保留“健康”肺的最大叶具有临床意义。本研究旨在报告肺移植在治疗上叶中央型肺癌中的应用。
纳入并分析3例肺癌病例。癌肿侵犯下肺叶支气管及边缘,肺动脉受转移淋巴结侵犯并被包绕。行全肺切除、体外低钾右旋糖酐(LPD)溶液顺灌及逆灌。从离体肺中选取可保留的下肺叶,将上肺静脉替换为下肺静脉。依次吻合支气管和肺动脉。
手术累计时间为220分钟至250分钟。下肺叶离体时间为120分钟至150分钟。胸部X线证实再植肺完全复张后拔除胸腔引流管。患者随访4个月至8个月,完成3或4周期辅助化疗。患者生活质量良好。
肺移植切除广泛肿瘤组织并保留最大肺正常组织是治疗肺癌的一种有效方法。