Okubo K, Wada H, Fukuse T, Yokomise H, Inui K, Mizuno H, Ike O, Hitomi S
Department of Thoracic Surgery, Kyoto University, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1995 Jul;43(7):941-5.
Operative technique and long-term results of seventeen patients with apical invading lung cancers were evaluated. External radiation therapy was administered preoperatively in all but one. Thirteen lobectomies, three wedge resections and one pneumonectomy were performed with combined resections of chest wall (and adjacent structures) 12, vertebra 3, brachicephalic vein 2, subclavian artery 1, lower part of brachial plexsus 3, sympathetic trunk 2 and phrenic nerve 1. Chest walls were reconstructed with marlex meshes in 5, the subclavian artery and one brachiocephalic vein were with artificial grafts. Operations were considered relative curative in 10, relative non-curative in 2 and absolutely non-curative in 5. Absolutely non-curative operations were due to cancer-positive stump of brachial plexus in the apex in four and metastatic lymph node invading aorta in one. Over all five-year survival rate was 35.3% and median survival was 20 months. Five-year survivals in patients with curative operations and non-curative operations were 60% and 0%, respectively, and the former was significantly higher. Surgical margin is a large factor for long-term result and invasion to the brachial plexus is thought to be a limiting factor for surgery.
对17例侵犯肺尖部的肺癌患者的手术技术及长期疗效进行了评估。除1例患者外，其余患者均在术前接受了外照射治疗。共进行了13例肺叶切除术、3例楔形切除术和1例全肺切除术，并联合切除胸壁（及相邻结构）12例、椎体3例、头臂静脉2例、锁骨下动脉1例、臂丛神经下部3例、交感干2例和膈神经1例。5例患者采用Marlex网片重建胸壁，1例锁骨下动脉和1例头臂静脉采用人工血管移植。手术被认为相对根治性的有10例，相对非根治性的有2例，绝对非根治性的有5例。绝对非根治性手术的原因是4例患者肺尖部臂丛神经残端癌阳性，1例患者转移性淋巴结侵犯主动脉。总体五年生存率为35.3%，中位生存期为20个月。根治性手术和非根治性手术患者的五年生存率分别为60%和0%，前者显著更高。手术切缘是影响长期疗效的重要因素，臂丛神经侵犯被认为是手术的限制因素。
