探讨肺癌根治术后局部复发、余肺再切除术的临床效果。

回顾性分析吉林省肿瘤医院胸外科2010年1月—2012年1月期间行肺癌根治术的1 127例患者的临床资料，持续随访5年，发现98例患者局部复发。根据患者的心肺功能和肿瘤临床分期分组，其中37例肺癌患者术后复发行再切除(开胸肺癌根治术16例，全胸腔镜下肺癌根治术21例)，61例行保守治疗(17例行单纯放疗，39例行靶向治疗，5例行中药及对症治疗)。

98例局部复发患者中，首次行开放手术的患者局部复发率为8.6%(57/665)，首次行胸腔镜手术的患者局部复发率为8.9%(41/462)，两组比较差异无统计学意义(P＝0.564)。但首次行胸腔镜手术的患者局部复发行再次手术的比例为51.2%(21/41)，显著高于首次行开放手术后再次手术的患者比例(28.1%，16/57)，差异有统计学意义(P＝0.039)。再次手术组患者术后1、3、5年生存率分别为86.5%(32/37)、40.5%(15/37)和29.7%(11/37)，保守治疗组为81.9%(50/61)、26.2%(16/61)和14.8%(9/61)，其中术后5年生存率比较差异有统计学意义(P＝0.048)。

严格掌握余肺切除术的适应证，对于原发性肺癌根治术后患者行术侧余肺全切除可获得较好的远期生存，是治疗肺癌术后复发的有效手段。首次行胸腔镜手术的患者局部复发后行再次手术的机会多于首次行开放手术的患者。

To investigate the clinical effect of partial resection of lung cancer after radical resection of lung cancer.

A retrospective analysis of the clinical data of 1 127 cases of Jilin Province Tumor Hospital Department of Thoracic Surgery from January 2010 to January 2012, during the period for radical resection of lung cancer patients, duration of 5 years of follow-up, 98 patients with local recurrence. According to the patient’s heart and lung function and the clinical stage of tumor, including 37 cases of lung cancer recurrence underwent re excision (thoracotomy for lung cancer in 16 cases, full thoracoscopic lung resection in 21 cases), 61 cases underwent conservative treatment (17 cases underwent radiotherapy, 39 cases of targeted therapy, 5 cases of traditional Chinese medicine and symptomatic treatment).

Ninety-eight cases of patients with local recurrence in patients with local recurrence, first open surgery rate was 8.6% (57/665), patients with local recurrence for thoracoscope surgery rate was 8.9% (41/462), the two groups had no statistically significant difference (P=0.564). But for the first time for thoracoscopic surgery in patients with relapse surgery department the proportion is 51.2% (21/41), significantly higher than the proportion of patients with reoperation for open surgery (28.1%, 16/57), the difference was statistically significant (P=0.039). Again 1, 3, 5 surgery group after survival, the rates were 86.5% (32/37), 40.5% (15/37) and 29.7% (11/37), significantly higher than those in the conservative group (81.9%) (50/61), 26.2% (16/61) and 14.8% (9/61) (P=0.048).

Strict control over pulmonary resection indications for primary lung cancer after radical surgery for patients with total resection of pulmonary side can get good survival, is an effective way to treat lung cancer recurrence after surgery. Patients with local recurrence after surgery again for the first time thoracoscope surgery more than open surgery patients for the first time.