切换至 "中华医学电子期刊资源库"
高级检索
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:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

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/OL]. 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/OL]. 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)
1
Gu C, Pan X, Wang R, et al. Analysis of mutational and clinicopathologic characteristics of lung adenocarcinoma with clear cell component[J]. Oncotarget, 2016, 7(17): 24596.
2
Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015[J]. CA: a cancer journal for clinicians, 2016, 66(2): 115-132.
3
Guo Y, Zeng H, Zheng R, et al. The burden of lung cancer mortality attributable to fine particles in China[J]. Sci Total Environ, 2017, 579: 1460-1466.
4
Deslauriers J, Grégoire J, Jacques LF, et al. Sleeve lobectomy versus pneumonectomy for lung cancer: a comparative analysis of survival and sites or recurrences[J]. Ann Thorac Surg, 2004, 77(4): 1152-1156.
5
Ludwig C, Stoelben E, Olschewski M, et al. Comparison of morbidity, 30-day mortality, and long-term survival after pneumonectomy and sleeve lobectomy for non–small cell lung carcinoma[J]. Ann Thorac Surg, 2005, 79(3): 968-973.
6
Pan X, Tantai J, Lin L, et al. Comparison of short and long-term results between sleeve resection and pneumonectomy in lung cancer patients over 70 years old: 10 years experience from a single institution in China[J]. Thoracic Cancer, 2014, 5(6): 494-499.
7
Johnston JB, Jones PH. The treatment of bronchial carcinoma by lobectomy and sleeve resection of the main bronchus[J]. Thorax, 1959, 14(1): 48.
8
Sagawa M, Aikawa H, Usuda K, et al. Extended sleeve pulmonary resection in a patient with synchronous triple bronchogenic squamous cell carcinoma[J]. Lung Cancer, 2008, 59(2): 262-265.
9
Miyoshi S, Tamura M, Araki O, et al. Telescoping bronchial anastomosis for extended sleeve lobectomy[J]. J Thorac Cardiovasc Surg, 2006, 132(4): 978-980.
10
Chida M, Minowa M, Miyoshi S, et al. Extended sleeve lobectomy for locally advanced lung cancer[J]. Ann Thorac Surg, 2009, 87(3): 900-905.
11
Gu C, Wang R, Pan X, et al. Comprehensive study of prognostic risk factors of patients underwent pneumonectomy[J]. J Cancer, 2017, 8(11): 2097.
12
Okada M, Yamagishi H, Satake S, et al. Survival related to lymph node involvement in lung cancer after sleeve lobectomy compared with pneumonectomy[J]. J Thorac Cardiovasc Surg, 2000, 119(4): 814-819.
13
Krüger M, Uschinsky K, H？？ler K, et al. Postoperative complications after bronchoplastic procedures in the treatment of bronchial malignancies[J]. Eur J Cardiothorac Surgery, 1998, 14(1): 46-53.
14
Jadczuk E. Mobilization of the pulmonary hilus from the pericardium in plastic surgery of the bronchi[J]. Wiad Lek，1998, 51(1-2): 30-34.
[1] 张晓宇, 殷雨来, 张银旭. 阿帕替尼联合新辅助化疗对三阴性乳腺癌的疗效及预后分析[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 346-352.
[2] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[3] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[4] 刘世君, 马杰, 师鲁静. 胃癌完整系膜切除术+标准D2根治术治疗进展期胃癌的近中期随访研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 27-30.
[5] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[6] 李华志, 曹广, 刘殿刚, 张雅静. 不同入路下行肝切除术治疗原发性肝细胞癌的临床对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 52-55.
[7] 常小伟, 蔡瑜, 赵志勇, 张伟. 高强度聚焦超声消融术联合肝动脉化疗栓塞术治疗原发性肝细胞癌的效果及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 56-59.
[8] 高杰红, 黎平平, 齐婧, 代引海. ETFA和CD34在乳腺癌中的表达及与临床病理参数和预后的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 64-67.
[9] 徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[10] 王露, 周丽君. 全腹腔镜下远端胃大部切除不同吻合方式对胃癌患者胃功能恢复、并发症发生率的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 92-95.
[11] 李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[12] 刘柏隆, 周祥福. 女性尿失禁吊带手术并发症处理的经验分享[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(01): 127-127.
[13] 董佳, 王坤, 张莉. 预后营养指数结合免疫球蛋白、血糖及甲胎蛋白对HBV 相关慢加急性肝衰竭患者治疗后预后不良的预测价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 555-559.
[14] 刘郁, 段绍斌, 丁志翔, 史志涛. miR-34a-5p 在结肠癌患者的表达及其与临床特征及预后的相关性研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 485-490.
[15] 王景明, 王磊, 许小多, 邢文强, 张兆岩, 黄伟敏. 腰椎椎旁肌的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 846-852.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号