肺癌支气管成形术后的发病率、死亡率和生存率。

Rea F, Loy M, Bortolotti L, Feltracco P, Fiore D, Sartori F

Section of Thoracic Surgery, University of Padua, Italy.

Eur J Cardiothorac Surg. 1997 Feb;11(2):201-5. doi: 10.1016/s1010-7940(96)01023-8.

OBJECTIVE

Bronchoplastic procedures represent an effective surgical therapy for benign lesions, tumors of low-grade malignancy and also bronchogenic carcinoma in patients with a limited pulmonary function. We analyzed our experience in order to verify the mortality, morbidity, and long term survival in our patients.

METHODS

From 1980 to 1994, 217 patients underwent bronchoplastic procedures. We performed 92 bronchoplasties, 94 bronchial sleeves, and 31 tracheo-bronchial sleeves. Histologic examination revealed 133 epidermoid carcinomas, 28 adenocarcinomas, 11 small cells lung cancers, 5 large cells carcinomas, 2 adenosquamous carcinomas, 29 bronchial carcinoids, 6 adenoidocistic carcinomas, and 3 mucoepidermoid tumors. Regarding nodal status, 99 patients had N0 disease, 64 patients had N1 disease, and 54 patients had N2 disease. Thirty-six patients had preoperative irradiation and 181 patients had no preoperative irradiation. In 63 patients we used a perianastomotic pedicled flap; in 154 we did not use it. We considered all the 217 patients for the analysis of 30-day mortality and morbidity; of the 217 patients we analyzed long-term survival only in 179 because we excluded 38 patients with low grade malignant neoplasm.

RESULTS

Twenty-seven patients (12.5%) had postoperative complications. The 30-day mortality was 6.2% (14 patients). Survival at 5 and 10 years for all patients but those with low grade malignant neoplasm was 49 and 38%, respectively. For patients with N0 status 5- and 10-year survival was 72.4 and 59.4%; for patients with N1 status these rates were 35.7 and 26.8%; for patients with N2 status, 5- and 10-year survival was 22 and 14.4%. Postoperative complication rates for patients with or without pedicled flap are not significantly different; however, the rates for patients with or without preoperative irradiation are significantly different.

CONCLUSIONS

Bronchoplastic procedures are a safe and effective therapy for selected patients with pulmonary malignancy. Tracheo-bronchial sleeves are associated with high postoperative mortality and complication rates and these procedures should be limited to patients without N2 disease. Preoperative irradiation increases significantly the mortality and morbidity. A multivariate analysis shows that only the nodal status affects long-term survival (P = 0.0002).

目的

支气管成形手术是治疗良性病变、低度恶性肿瘤以及肺功能受限患者支气管源性癌的一种有效手术疗法。我们分析了我们的经验，以验证患者的死亡率、发病率和长期生存率。

方法

1980年至1994年，217例患者接受了支气管成形手术。我们实施了92例支气管成形术、94例支气管袖状切除术和31例气管-支气管袖状切除术。组织学检查显示有133例表皮样癌、28例腺癌、11例小细胞肺癌、5例大细胞癌、2例腺鳞癌、29例支气管类癌、6例腺样囊性癌和3例黏液表皮样瘤。关于淋巴结状态，99例患者为N0期疾病，64例患者为N1期疾病，54例患者为N2期疾病。36例患者术前行放疗，181例患者未行术前放疗。63例患者使用了吻合口周围带蒂皮瓣；154例未使用。我们将所有217例患者纳入30天死亡率和发病率分析；在217例患者中，我们仅对179例进行了长期生存分析，因为我们排除了38例低度恶性肿瘤患者。

结果

27例患者（12.5%）出现术后并发症。30天死亡率为6.2%（14例患者）。除低度恶性肿瘤患者外，所有患者的5年和10年生存率分别为49%和38%。N0期患者的5年和10年生存率分别为72.4%和59.4%；N1期患者的这些比率分别为35.7%和26.8%；N2期患者的5年和10年生存率分别为22%和14.4%。使用或未使用带蒂皮瓣患者的术后并发症发生率无显著差异；然而，术前行放疗或未行放疗患者的并发症发生率有显著差异。