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背景与目的为了最大限度地保留正常肺组织,提高中央型肺癌患者术后的生活质量,气管、支气管成形术被应用于中央型肺癌的治疗并取得了较好的效果。本研究的目的是探讨气管、支气管成形术治疗中央型肺癌的适应证和术中处理及并发症防治。方法分析1988年6月~2004年10月76例接受气管、支气管成形术治疗的中央型肺癌患者的临床资料,其中鳞癌49例,腺癌16例,腺鳞癌7例,小细胞癌3例,腺样囊腺癌1例;Ⅰ期17例,Ⅱ期39例,ⅢA期17例,ⅢB期3例。76例中行袖状肺叶切除术55例,肺叶并主支气管楔形切除术12例,一侧肺上叶支气管—主支气管—气管侧壁大弧形切除8例,右肺上叶并右主气管—隆凸和气管下段切除以及气管与左主支气管、右中间支气管与左主支气管吻合1例;合并左肺动脉干楔形切除术3例,合并左心房局部切除2例,合并胸壁整块切除2例。结果术后7例出现并发症,其中6例并发肺部感染、肺不张,且1例发展至心肺功能衰竭而死亡;1例术后合并上消化道大出血而死亡。全组随访率为93.4%(71/76)。术后1、3、5年生存率分别为82.4%(56/68)、57.8%(26/45)和41.7%(15/36)。结论气管、支气管成形术治疗中央型肺癌是可行的,该术式不仅能最大限度地保留肺组织,提高患者术后生活质量,且为部分肺功能差的患者提供了切除病变的机会。
BACKGROUND & OBJECTIVE: To maximize the retention of normal lung tissue and improve the postoperative quality of life of patients with central lung cancer, trachea and bronchoplasty were applied to the treatment of central lung cancer and achieved good results. The purpose of this study is to explore tracheal and bronchoplasty indications for central lung cancer and intraoperative management and prevention and treatment of complications. Methods Clinical data of 76 patients with central lung cancer undergoing tracheal and bronchoplasty from June 1988 to October 2004 were analyzed. Among them, 49 were squamous cell carcinoma, 16 adenocarcinoma, 7 adenosquamous carcinoma, 3 small cell carcinoma For example, adenoid cystadenocarcinoma was found in 1 case; stage Ⅰ in 17 cases, stage Ⅱ in 39 cases, stage ⅢA in 17 cases and stage ⅢB in 3 cases. Sixty-six cases of middle lobe sleeve lobe resection in 55 cases, lobes and main bronchial wedge resection in 12 cases, one side of the lung lobes bronchus - the main bronchus - trachea wall arcuate resection in 8 cases, right upper lobe and the right main trachea - One case of anastomosis of the left main bronchus with left main bronchus and right middle bronchus and left main bronchus were resected. Three cases of wedge resection of the left pulmonary artery combined with partial resection of the left atrium in 2 cases and 2 cases of combined thoracic wall resection. Results Postoperative complications occurred in 7 patients, of which 6 were complicated by pulmonary infection and atelectasis, and 1 died of cardiorespiratory failure. One patient died of upper gastrointestinal bleeding after operation. The whole group follow-up rate was 93.4% (71/76). The 1, 3, 5-year survival rates were 82.4% (56/68), 57.8% (26/45) and 41.7% (15/36), respectively. Conclusions Trachea and bronchoplasty are feasible for the treatment of central lung cancer. The technique not only maximizes the retention of lung tissue and improves postoperative quality of life, but also provides some patients with poor lung function with the opportunity of resection of the lesion.