Rusca M, Soliani P, Cattelani L, Covizzi M
Istituto de Clinica Chirurgica Generale, Toracica e Vascolare, Università degli Studi di Parma.
Acta Biomed Ateneo Parmense. 1989;60(3-4):191-6.
Diagnostic imaging and mediastinoscopy have reduced but not eliminated the exploratory thoracotomy in the management of lung cancer patients. Considering all the limits of such diagnostic techniques, an aggressive approach to lung neoplasm imply an increase both in explorative thoracotomies and in radical or palliative intraoperative procedures. Our study includes 55 explorative thoracotomies performed on 206 surgical operations for lung cancer. The patients of E.T.'s group couldn't undergo surgical resection in 28 cases because of direct tumoral mediastinal diffusion, involving cardio-pericardial wall and/or great vessels; in 20 for extensive nodal mediastinal diffusion, in 3 patients for pleural dissemination, and 4 had unresectable chest wall involvement. Postoperative mortality rate was 3.6% vs. 5.5% recorded in resected patients; postoperative morbidity rate was 9%. During explorative operations became possible to define more exactly diagnosis and, through palliative procedures, to improve life quality: in fact we performed tumor histology correction or settlement (12/55 P.ts), pericardiotomy for pericardial effusion (5/55 P.ts), pleurodesis or pleurectomy when pleural effusion was present (16/55 p.ts), intercostal neurolysis in involved chest wall areas (4/55 p.ts).
诊断性影像学检查和纵隔镜检查已减少了肺癌患者管理中探索性开胸手术的使用，但并未消除该手术。考虑到这些诊断技术的所有局限性，对肺肿瘤采取积极的治疗方法意味着探索性开胸手术以及根治性或姑息性术中操作都会增加。我们的研究包括对206例肺癌手术患者进行的55例探索性开胸手术。在探索性开胸手术组的患者中，有28例因肿瘤直接扩散至纵隔，累及心脏心包壁和/或大血管而无法进行手术切除；20例因广泛的纵隔淋巴结扩散，3例因胸膜播散，4例因胸壁无法切除的受累而无法手术。探索性开胸手术组的术后死亡率为3.6%，而切除患者的术后死亡率为5.5%；术后发病率为9%。在探索性手术中，可以更准确地确定诊断，并通过姑息性手术提高生活质量：事实上，我们进行了肿瘤组织学校正或确定（12/55例患者）、心包切开术治疗心包积液（5/55例患者）、存在胸腔积液时进行胸膜固定术或胸膜切除术（16/55例患者）、对受累胸壁区域进行肋间神经松解术（4/55例患者）。
