隆凸切除及重建术治疗隆凸肿瘤及支气管肺癌35例经验

目的：探讨隆凸切除及重建术治疗隆凸,主支气管肿瘤及中央型支气管肺癌的手术方式及围术期管理。方法：隆凸,主支气管肿瘤8例,中央型支气管肺癌27例,其中侵犯左心房5例,行单纯隆凸切除重建5例,右上肺叶切除及隆凸切除重建18例,右全肺隆凸切除4例,左全肺隆凸切除4例,右上肺叶切除及隆凸切除重建4例,加行部分左心房切除5例,手术采用了11种不同类型的隆凸切除重建方式。结果：本组无手术死亡,无吻合口瘘,肺部感染7例,呼吸功能不全1例,全肺不张1例,隆凸,主支气管肿瘤患者术后无瘤生成17月－7年,中央型支气管肺癌患者术后1年生存率96．3％,3年生存率70．1％,5年生存率37．0％,有5例生存10年以上。结论：通过仔细术前评估,熟练的手术操作,良好的术后管理,配合术后综合治疗,可大大降低隆凸手术的死亡率和并发症,并获得满意的远期效果。

Experience in carinal resection and reconstruction in the treatment of carinal tumor and bronchogenic carcinoma (A report of 35 cases)

Objective To summarize the experience of carinal resection and reconstruction about the surgical technique and perioperative management in the treatment of carinal and stem bronchial tumor and central bronchogenic carcinoma. Methods Eight cases of carinal and stem bronchial tumor and 27 cases of central bronchogenic carcinoma were included in this group, in which the left atrium was invaded in 5 cases. Types of surgery included carinal resection and reconstruction without pulmonary resection in 5 cases, carinal resection and reconstruction plus right upper lobectomy 18 cases, right carinal pneumonectomy 4 cases, left carinal pneumonectomy 4 cases, and carinal resection and recontruction plus left upper lobectomy 4 cases. Five patients underwent additional partial resection of left atrium. There were 11 different modes of carinal resection and reconstruction in this series. Results There were no operative death and no anastomotic leakage. Pneumonia was seen in 7 patients, impaired pulmonary function in 1 patient and atelectasis of the entire lung in one patient. Patients with carinal or stem bronchial neoplasms lived free of tumor for 17 months to 7 years after operation. The 1 , 3 and 5 year survival rates in patients with central bronchogenic carcinoma were 96.3%, 70.1% and 37.0% respectively. Five patients had survived more than 10 years. Conclusion Careful preoperative assessment, skillful surgical technique and proper postoperative management combined with appropriate postoperative therapy would be crucial for great reduction of operative death and morbidity of carinal resection and reconstruction, and also helpful for remote outcome.