Weisel R D, Cooper J D, Delarue N C, Theman T E, Todd T R, Pearson F G
J Thorac Cardiovasc Surg. 1979 Dec;78(6):839-49.
Sleeve lobectomy for non-oat cell carcinoma involving a major bronchus preserves functioning lung tissue and, in carefully selected patients, provides long-term survival comparable to pneumonectomy. Seventy patients underwent sleeve lobectomy between 1967 and 1978. Twenty-seven patients were considered compromised (Group I) because they had severe respiratory impairment which contraindicated pneumonectomy. Forty-three patients were considered uncompromised (Group 2) and underwent elective sleeve lobectomy. Seventy patients with a similar non-oat cell carcinoma involving the proximal bronchi underwent pneumonectomy (Group 3) during this period. Perioperative complications occurred more frequently in Group 1 (59%) than in Group 2 (21%) or Group 3 (23%). Both periopeative mortality rate and the incidence of bronchial disruption (bronchovascular and bronchopleural fistulas) were higher in Group I (19% and 22%) than in Group 2 (9% and 5%) or Group 3 (3% and 7%). Survival depended primarily on the surgeon's ability to perform a complete resection of the tumor. An incomplete resection resulted when tumor was found in the highest lymph node or in the last bronchial resection margin when paraffin sections were reviewed. The 5 year survival rate was 18% for compromised patients (Group 1) who underwent complete resection, and there were no survivors among patients undergoing incomplete resections. Uncompromised patients ( Group 2) had a 5 year survival rate of36% with complete and 12% with incomplete resections. Pneumonectomy patients (Group 3) had a 64% 5 year survival rate with a complete resection and 16% with an incomplete resection. The stage of the disease at the time of operation had a profound effect on the survivail. There was no difference inthe 5 and 8 year survival rates between uncompromised patients undergoing sleeve resection ( Group 2) and patients undergoing peneumonectomy (Group 3) for comparable stage of their disease. A careful pre- and postoperative functional assessment revealed that pulmonary performance was improved in 44% of Group 1, 63% of Group 2, and only 14% of Group 3 patients. Patients wiht impaired pulmonary reserve underwent sleeve lobectomy with an adequate disease-free interval when complete tumor excision was possible. Uncompromised patients whose extensive disease required incomplete resection had palliation by sleeve lobectomy equivalent to that by pneumonectomy. When complete t-mor resection was possible, patients with uncompromised pulmonary reserve had a perioperative complication rate and long-term survival equivalent to that of pneumonectomy while preserving pulmonary parenchyma, which permitted an improvement in postoperative pulmonary performance.
对于累及主支气管的非燕麦细胞癌，袖状肺叶切除术可保留有功能的肺组织，并且在经过精心挑选的患者中，其长期生存率与肺切除术相当。1967年至1978年间，70例患者接受了袖状肺叶切除术。27例患者被认为情况较差（第1组），因为他们有严重的呼吸功能损害，这是肺切除术的禁忌证。43例患者被认为情况较好（第2组），接受了择期袖状肺叶切除术。在此期间，70例患有类似近端支气管非燕麦细胞癌的患者接受了肺切除术（第3组）。围手术期并发症在第1组（59%）中比在第2组（21%）或第3组（23%）中更频繁地发生。围手术期死亡率和支气管破裂（支气管血管瘘和支气管胸膜瘘）的发生率在第1组（19%和22%）中高于第2组（9%和5%）或第3组（3%和7%）。生存率主要取决于外科医生完整切除肿瘤的能力。当石蜡切片复查时，若在最高位淋巴结或最后支气管切除边缘发现肿瘤，则为不完全切除。接受完整切除的情况较差患者（第1组）的5年生存率为18%，接受不完全切除的患者无幸存者。情况较好的患者（第2组）完整切除后的5年生存率为36%，不完全切除后的为12%。肺切除术患者（第3组）完整切除后的5年生存率为64%，不完全切除后的为16%。手术时疾病的分期对生存率有深远影响。对于疾病分期相当的情况较好的患者，接受袖状切除术（第2组）和接受肺切除术（第3组）的患者在5年和8年生存率上没有差异。仔细的术前和术后功能评估显示，第1组44%、第2组63%、第3组仅14%的患者肺功能得到改善。肺储备功能受损的患者在可能完整切除肿瘤时，在适当的无病间期接受袖状肺叶切除术。广泛疾病需要不完全切除的情况较好的患者，袖状肺叶切除术的姑息效果与肺切除术相当。当可能完整切除肿瘤时，肺储备功能良好的患者围手术期并发症发生率和长期生存率与肺切除术相当，同时保留了肺实质，这使得术后肺功能得到改善。
