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中华胸部外科电子杂志

中华胸部外科电子杂志 ›› 2017, Vol. 04 ›› Issue (04) : 204 -208. doi: 10.3877/cma.j.issn.2095-8773.2017.04.02

所属专题： 文献；

论著

扩大袖型切除术治疗中央型肺癌30例经验总结
潘旭峰1, 顾畅1, 傅世杰1, 杨骏1, 赵珩1,†()   
  1. 1. 200030　上海交通大学附属胸科医院胸外科
  • 收稿日期:2017-09-20 出版日期:2017-11-28
  • 通信作者: 赵珩
  • 基金资助:
    上海市卫计委局青课题(20144Y0169)

The experience of 30 extended sleeve lobectomy cases in the treatment of central lung cancer

Xufeng Pan1, Chang Gu1, Shijie Fu1, Jun Yang1, Heng Zhao1,†()   

  1. 1. Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
  • Received:2017-09-20 Published:2017-11-28
  • Corresponding author: Heng Zhao
  • About author:
    Corresponding author: Zhao Heng, Email:
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潘旭峰, 顾畅, 傅世杰, 杨骏, 赵珩. 扩大袖型切除术治疗中央型肺癌30例经验总结[J]. 中华胸部外科电子杂志, 2017, 04(04): 204-208.

Xufeng Pan, Chang Gu, Shijie Fu, Jun Yang, Heng Zhao. The experience of 30 extended sleeve lobectomy cases in the treatment of central lung cancer[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2017, 04(04): 204-208.

目的

探讨扩大袖型切除对中央型肺癌的治疗效果。

方法

2014年3月—2015年9月，上海市胸科医院对30例中央型肺癌患者行经扩大袖型切除术治疗的，对相关临床资料、手术方式、并发症以及随访情况做一总结。

结果

全组患者无术中或住院期间死亡病例，24例(80.0%)患者取得彻底(R0)切除。所有患者中，鳞癌占绝大多数(20/30，66.7%)，其次为腺癌(6/30，20.0%)。从手术切除范围来看，涉及一叶加段切的扩大袖型切除14例(46.7%)，涉及两叶的扩大袖型切除16例(53.3%)。共有14例(46.7%)患者发生并发症，其中术中或术后输血5例，术后不同程度皮下气肿、心律失常、肺部感染各3例，支气管胸膜瘘和肺不张各2例，乳糜胸1例。患者1、2、3年总生存率分别为80.0%、56.3%和44.4%。

结论

对于局部晚期中央型肺癌，尤其肺功能不佳的患者，扩大袖型切除可以作为全肺切除术的一种代替治疗手段。

关键词: 扩大袖型切除术, 中央型肺癌, 并发症, 预后
Objective

To discuss the surgical outcomes of extended sleeve resection for centrally-located lung cancer.

Methods

A retrospective study of 30 patients with centrally-located lung cancer who received extended sleeve resection from March 2014 to September 2015 in Shanghai Chest Hospital. The corresponding data including clinical presentation, operation procedure, perioperative complications and follow-up examinations were reviewed.

Results

There was no intraoperative or perioperative death. 24 of 30 patients underwent complete resection. In all patients, squamous cell carcinoma accounted for the vast majority (20/30, 66.7%), followed by adenocarcinoma (6/30, 20.0%). From the scope of surgical resection, there were 14 cases (46.7%) involving enlarged lobectomy with one-lobed plus segmental resection, and 16 cases (53.3%) involving enlarged two-lobed resection. In our study, there were 14 patients who suffered from postoperative complications, including transfusion in 5 patients, subcutaneous emphysema in 3 patients, arrhythmia in 3 patients, pulmonary infection in 3 patients, bronchopleural fistula in 2 patients, pulmonary atelectasis in 2 patients and chylothorax in 1 patient. During follow-up period, the survival rates for 1-year, 2-year and 3-year were 80%, 56.3% and 44.4%, respectively.

Conclusions

For patients with centrally-located lung cancer, if technique available, extended sleeve resection is an alternative to pneumonectomy.

Key words: Extended sleeve resection, Centrally-located lung cancer, Complications, Prognosis
表1 30例中央型肺癌患者术前基本情况
临床资料 病例数(%)
年龄(岁) 59.9 (42～77)
性别 ?
? 男性 28 (93.3)
? 女性 2 (6.7)
吸烟史 ?
? 无 6 (20)
? 有 24 (80)
BMI(kg/m2) 24.1 (17.9～31.5)
合并症 ?
? 高血压 3 (10.0)
? 冠心病 2 (6.7)
? 糖尿病 1 (3.3)
ASA分级 ?
? Ⅱ级 20 (66.7)
? Ⅲ级 10 (33.3)
肺功能 ?
? FEV1% 76.9(47.2～105.0)
? DLCO% 80.6(44.2～124.3)
表2 30例中央型肺癌患者经扩大袖型切除术围术期临床资料
临床指标 病例数(%)
手术时间(min) 162.2 (88～279)
术中出血量(ml) 252 (100～1000)
手术方式 ?
? LL＋S4/5 7 (23.3)
? LU＋S6 4 (13.3)
? RL＋S2 1 (3.3)
? RM＋RL 9 (30.0)
? RU＋RM 7 (23.3)
? RU＋S6 2 (6.7)
淋巴结清扫站数 8.5 (4～13)
淋巴结清扫个数 15.5 (6～32)
围术期放化疗 ?
? 术前化疗 7 (23.3)
? 术后化疗 19 (63.3)
? 术后放疗 7 (23.3)
肿瘤病理类型 ?
? 腺癌 6 (20.0)
? 鳞癌 20 (66.7)
? 其他 4 (13.3)
手术切端 ?
? R0 24 (80.0)
? R1 6 (20.0)
肿瘤TNM分期 ?
? Ⅰa＋Ⅰb 9(30.0)
? Ⅱa＋Ⅱb 10(33.3)
? Ⅲa 10(33.3)
? Ⅳ 1(3.3)
肿瘤最大径(cm) 4.3(1.5～8)
肿瘤T分期 ?
? T1a＋T1b 6(20.0)
? T2a＋T2b 20(66.7)
? T3 2(6.7)
? T4 2(6.7)
肿瘤N分期 ?
? N0 9(30.0)
? N1 14(46.7)
? N2 7(23.3)
肿瘤分化程度 ?
? 高分化 1(3.3)
? 中分化 8(26.7)
? 低分化 17(56.7)
? 未知 4(13.3)
图1 30例中央型肺癌经扩大袖型切除患者的生存曲线
表3 30例中央型肺癌患者经扩大袖型切除术后情况
术后指标 病例数(%)
术后住院时间(d) 10.4(5～21)
ICU时间(d) 1.9(0～7)
引流时间(d) 8(3～20)
并发症 ?
? 皮下气肿 3(10.0)
? 心律失常 3(10.0)
? 肺部感染 3(10.0)
? 乳糜胸 1(3.3)
? 肺不张 2(6.7)
? 支气管胸膜瘘 2(6.7)
? 输血 5(16.7)
? 术中大出血(>800ml) 1(3.3)
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