Zhang Bao-shi, Yu Chang-hai, Zhang Yi-ming, Yu Jian-qi, Zhou Nai-kang
Department of Thoracic Surgery, General Hospital of PLA, Beijing 100853, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2010 Nov;30(11):2509-11.
To explore the value of partial atrium or large blood vessel resection for the treatment of locally advanced lung cancer.
Thirty-five patients with locally advanced lung cancer (T(4)N(0)-N(2)M(0)) underwent lobectomy or pneumonectomy combined with intrapericardial vascular management or partial resection of the atrium. Of the 35 patients , 15 underwent left pneumonectomy combined with partial resection of the left atrium, 3 had pneumonectomy and partial resection of pulmonary artery trunk, 11 received right pneumonectomy and partial resection of the left atrium, 3 had middle and lower lobectomies and partial resection of the left atrium, and 3 underwent right upper lobectomy, partial resection of the superior vena cava and replacement of artificial blood vessel.
No death occurred in the 35 patients. Postoperative arrhythmia occurred in 4 cases and respiratory failure in 2 cases. The 1, 2, 3 and 4 year survival rates of the patients were 79.2% (19/24), 53.3% (8/15), 46.2% (6/13) and 36.4% (4/11), respectively. Pathologically, 27 patients had squamous carcinoma, 3 had adenocarcinoma, 3 had adenosquamous carcinoma and 2 had large cell carcinoma. In TNM staging, 6 were in T(4)N(0)M(0), 11 in T(4)N(1)M(0) and 18 in T(4)N(2)M(0).
Pneumonectomy or lobectomy combined with intrapericardial vascular management or partial resection of the atrium can enhance the possibility of radical resection of locally advanced lung cancer and increase the long term survival rate.
探讨部分心房或大血管切除在局部晚期肺癌治疗中的价值。
35例局部晚期肺癌(T(4)N(0)-N(2)M(0))患者接受了肺叶切除术或全肺切除术,并联合心包内血管处理或部分心房切除。35例患者中,15例行左全肺切除术并左心房部分切除术,3例行全肺切除术并肺动脉主干部分切除术,11例行右全肺切除术并左心房部分切除术,3例行中、下肺叶切除术并左心房部分切除术,3例行右上肺叶切除术、上腔静脉部分切除术及人工血管置换术。
35例患者均无死亡。术后4例发生心律失常,2例发生呼吸衰竭。患者的1、2、3和4年生存率分别为79.2%(19/24)、53.3%(8/15)、46.2%(6/13)和36.4%(4/11)。病理检查显示,27例为鳞状细胞癌,3例为腺癌,3例为腺鳞癌,2例为大细胞癌。在TNM分期中,6例为T(4)N(0)M(0),11例为T(4)N(1)M(0),18例为T(4)N(②)M(0)。
肺切除术或肺叶切除术联合心包内血管处理或部分心房切除可提高局部晚期肺癌根治性切除的可能性,并提高长期生存率。