Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
Eur J Cardiothorac Surg. 2012 Jul;42(1):77-81. doi: 10.1093/ejcts/ezr291. Epub 2012 Jan 20.
Sleeve resection is the operation of choice in patients with centrally located tumours, in order to avoid a pneumonectomy. Most surgeons protect the bronchial anastomoses with tissue to prevent insufficiencies. The purpose of this study is to report on outcome of unwrapped bronchial anastomoses, especially after neoadjuvant chemo- or chemoradiotherapy.
Between 2000 and 2010, 103 patients [59 years (range 16-80), 40 females] underwent bronchial sleeve resections without coverage of the anastomosis with a tissue flap. We retrospectively reviewed the data for morbidity, mortality and survival, especially with regard to the type of resection, neoadjuvant therapy and stage.
Sleeve lobectomy was performed in 88, sleeve bilobectomy in 8, sleeve pneumonectomy in 4 and sleeve resection of the main bronchus in 3 patients. Twenty-seven patients had a combined vascular sleeve resection. Neoadjuvant chemotherapy was performed in 20 and radiochemotherapy in 5 patients. Non-small cell lung cancer (NSCLC) was present in 76 patients (squamous cell carcinoma in 44, adenocarcinoma in 24, large cell carcinoma in 6 and mixed cell in 2) and neuroendocrine tumour in 20 and other histological types in 7 patients. The pathologic tumour stage in NSCLC was stage I in 26, stage II in 26, stage IIIA in 16, stage IIIB in 7 and stage IV in 1 patient. There were no anastomotic complications, especially no fistulas. One patient developed narrowing of the intermediate bronchus without need for intervention. Twenty-four patients had early postoperative complications, including 11 surgery-related complications (air leakage, nerve injury, haemothorax or mediastinal emphysema). The 30-day mortality was 3% (one patient died due to heart failure and two with multiorgan failure). The 5-year survival rate was 63% in NSCLC patients and 86% in neuroendocrine tumour patients.
Sleeve resection without wrapping the bronchial anastomoses with a tissue flap is safe even in patients who underwent neoadjuvant chemo- or chemoradiotherapy. Therefore, wrapping of the bronchial anastomoses is not routinely mandatory.
在中央型肿瘤患者中，袖状切除术是首选的手术方式，以避免全肺切除术。大多数外科医生使用组织保护支气管吻合口，以防止吻合口不足。本研究的目的是报告未包裹的支气管吻合口的结果，尤其是在新辅助化疗或放化疗后。
2000 年至 2010 年间，103 例患者[59 岁（16-80 岁），40 例女性]接受了支气管袖状切除术，未使用组织瓣覆盖吻合口。我们回顾性分析了发病率、死亡率和生存率的数据，特别是与切除类型、新辅助治疗和分期有关的数据。
行袖状肺叶切除术 88 例，袖状双肺叶切除术 8 例，袖状全肺切除术 4 例，主支气管袖状切除术 3 例。27 例患者行联合血管袖状切除术。20 例患者接受新辅助化疗，5 例患者接受放化疗。76 例患者为非小细胞肺癌（鳞癌 44 例，腺癌 24 例，大细胞癌 6 例，混合细胞癌 2 例），20 例为神经内分泌肿瘤，7 例为其他组织学类型。非小细胞肺癌的病理肿瘤分期为Ⅰ期 26 例，Ⅱ期 26 例，Ⅲ A 期 16 例，Ⅲ B 期 7 例，Ⅳ期 1 例。无吻合口并发症，特别是无瘘管。1 例患者出现中间支气管狭窄，无需干预。24 例患者发生早期术后并发症，包括 11 例手术相关并发症（气胸、神经损伤、血胸或纵隔气肿）。30 天死亡率为 3%（1 例患者死于心力衰竭，2 例患者死于多器官衰竭）。非小细胞肺癌患者的 5 年生存率为 63%，神经内分泌肿瘤患者的 5 年生存率为 86%。
即使在接受新辅助化疗或放化疗的患者中，不使用组织瓣包裹支气管吻合口的袖状切除术也是安全的。因此，常规包裹支气管吻合口并非必需。
