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目的:探索肺叶切除加支气管和肺动脉双袖状切除治疗中央型肺癌的手术方法和效果。方法:1995年3月至2008年7月,对27例肿瘤同时侵犯上肺叶支气管开口及主支气管和肺动脉干但未侵犯下肺叶的中央型肺癌,采用支气管和肺动脉双袖状肺叶切除技术将肿瘤完整切除,再将保留的下叶支气管与主支气管残端吻合、下叶肺动脉与肺动脉干对端吻合。其中左上肺双袖状切除术21例,右中上肺双袖状切除术5例,右上肺双袖状切除术1例。结果:鳞癌20例,腺癌3例,小细胞未分化癌3例,腺鳞癌1例。术后心律不齐3例,经对症治疗好转;咳痰不畅、阻塞性肺炎、肺不张2例,经纤支镜吸痰后肺复张良好。突发大咯血死亡1例。术后生存情况:生存时间1年者77.78%(21/27),3年66.67%(8/12),5年75.00%(6/8)。结论:支气管和肺动脉双袖状肺叶切除术可最大限度地切除肺肿瘤,且保留了患者的健康肺组织,避免了全肺切除,患者术后的生活质量良好。
Objective: To explore the surgical methods and effects of lobectomy combined with double-sleeve resection of bronchial and pulmonary arteries in the treatment of central lung cancer. Methods: From March 1995 to July 2008, 27 cases of tumors simultaneously invaded central bronchus of upper lobe bronchial opening and main bronchus and pulmonary artery but did not infrate the lower lobes. The bronchial and pulmonary double-sleeve lobectomy was used to treat the tumor Complete resection, and then retain the lower lobe bronchi and the main bronchial stump anastomosis, lower lobe pulmonary artery and pulmonary artery anastomosis. Among them, there were 21 cases of double-sleeve left upper quadrant resection, 5 cases of double-arm right middle-upper lung resection and 1 case of double-sleeve right upper quadrant resection. Results: There were 20 cases of squamous cell carcinoma, 3 cases of adenocarcinoma, 3 cases of small cell undifferentiated carcinoma and 1 case of adenosquamous carcinoma. Postoperative arrhythmia in 3 cases, the symptomatic treatment improved; poor sputum, obstructive pneumonia, atelectasis in 2 cases, after bronchoscopy suction lungs good postoperative recovery. Sudden death from massive hemoptysis in 1 case. Postoperative survival was 77.78% (21/27) for 1 year survival, 66.67% (8/12) for 3 years and 75.00% (6/8) for 5 years. CONCLUSIONS: Both bronchial and pulmonary double-sleeve lobectomy can remove the lung tumor to the maximum and retain the healthy lung tissue of the patient, avoiding the pneumonectomy, and the quality of life after the operation is good.