Miller J I, Hatcher C R
Joseph B. Whitehead Department of Surgery, Emory University School of Medicine, Atlanta, GA.
Ann Thorac Surg. 1987 Oct;44(4):340-3. doi: 10.1016/s0003-4975(10)63785-x.
Surgical resection is the treatment of choice for non-small cell bronchogenic carcinoma, and it is the only method providing prolonged arrest and chance for cure. From 1974 through 1984, 32 patients with marked impairment of pulmonary function had a limited resection for carcinoma of the lung. Marked impairment is defined as a maximum breathing capacity less than 35 to 40% of predicted, forced expiratory volume in one second less than or equal to 1 liter, and forced expiratory flow (FEV25-75) of less than or equal to 0.6 liter. Limited resection is defined as an operation that is less than a lobectomy, generally a wide wedge or segmental resection. The pathological stage of disease was Stage I in 31 patients and Stage II in 1 patient. Ten patients were treated by segmental resection and 22 by wide wedge resection. Two-year and three-year survival is 84 and 78%, respectively, and 10 patients (31%) have survived for five years. Recurrent disease developed in 8 patients, 5 of whom died. Recurrence was highest when the lesion crossed an intersegmental plane. In 1978, postoperative radiation therapy was added to the treatment of all patients whose lesion crossed an intersegmental plane. Since then, 18 patients have undergone wedge resection and postoperative irradiation with only 2 local recurrences at two years.
手术切除是非小细胞支气管肺癌的首选治疗方法，也是唯一能提供长期缓解和治愈机会的方法。1974年至1984年期间，32例肺功能严重受损的患者接受了肺癌局限性切除术。严重受损定义为最大呼吸容量低于预测值的35%至40%，一秒用力呼气量小于或等于1升，用力呼气流量（FEV25-75）小于或等于0.6升。局限性切除定义为手术范围小于肺叶切除术，通常为广泛楔形或节段性切除。疾病的病理分期为I期31例，II期1例。10例患者接受节段性切除，22例接受广泛楔形切除。两年和三年生存率分别为84%和78%，10例患者（31%）存活了五年。8例患者出现复发，其中5例死亡。当病变跨越节段间平面时，复发率最高。1978年，对所有病变跨越节段间平面的患者在治疗中增加了术后放疗。从那时起，18例患者接受了楔形切除和术后放疗，两年时仅2例局部复发。
