Errett L E, Wilson J, Chiu R C, Munro D D
J Thorac Cardiovasc Surg. 1985 Nov;90(5):656-61.
Although lobectomy is the procedure of preference for patients with peripheral, clinical Stage I bronchogenic carcinomas, wedge resection of the tumor may be a satisfactory alternative in poor-risk patients. Between 1965 and 1982, 197 patients with peripheral bronchogenic carcinomas were operated upon. Clinical staging was established by radiography, bronchoscopy, and mediastinoscopy. Ninety-seven patients underwent lobectomies and 100 had wedge resections. The decision to perform the wedge resection was made preoperatively in the majority of cases based on the assessment of operative risks. Compared to lobectomy patients, those who had wedge resections were older (70.3 +/- 0.5 versus 64.9 +/- 0.5 years, p less than 0.001) and had a lower 1 second forced expiratory volume (1.56 +/- 0.03 versus 1.94 +/- 0.03 ml, p less than 0.001), a lower arterial oxygen tension (70.5 +/- 1.1 versus 75.6 +/- 1.2 mm Hg, p less than 0.01), and a higher arterial carbon dioxide tension (41.7 +/- 0.6 versus 38.7 +/- 0.3 mm Hg, p less than 0.001). Despite their compromised preoperative respiratory functional status, the wedge resection group had a 30 day operative mortality (3% versus 2.1%) and morbidity comparable to those of the lobectomy group. Actuarial life-table analysis indicates the cumulative survival rate at 2 years after operation to be virtually identical between wedge and lobectomy groups (72% versus 74%), and even at 6 years the differences in survival rates (69% versus 75%) were not statistically significant. We conclude, therefore, that by performing wedge resections in selected poor-risk patients, one may reduce the operative mortality and morbidity to an acceptable range without seriously compromising their long-term survival.
虽然肺叶切除术是外周型临床I期支气管癌患者的首选手术方式，但对于手术风险高的患者，肿瘤楔形切除术可能是一种令人满意的替代方法。1965年至1982年间，对197例外周型支气管癌患者进行了手术。通过放射学、支气管镜检查和纵隔镜检查进行临床分期。97例患者接受了肺叶切除术，100例进行了楔形切除术。大多数病例术前根据手术风险评估决定进行楔形切除术。与肺叶切除术患者相比，接受楔形切除术的患者年龄更大（70.3±0.5岁对64.9±0.5岁，p<0.001），第1秒用力呼气量更低（1.56±0.03对1.94±0.03 ml，p<0.001），动脉血氧分压更低（70.5±1.1对75.6±1.2 mmHg，p<0.01），动脉血二氧化碳分压更高（41.7±0.6对38.7±0.3 mmHg，p<0.001）。尽管楔形切除术组患者术前呼吸功能状态较差，但该组30天手术死亡率（3%对2.1%）和发病率与肺叶切除术组相当。精算生命表分析表明，楔形切除术组和肺叶切除术组术后2年的累积生存率几乎相同（72%对74%），甚至在6年时生存率差异（69%对75%）也无统计学意义。因此，我们得出结论，通过对选定的手术风险高的患者进行楔形切除术，可以将手术死亡率和发病率降低到可接受的范围，而不会严重影响其长期生存。
