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目的总结左心房部分切除技术治疗局部晚期肺癌的临床经验。方法1997年7月～2008年8月,40例肿瘤累及左心房的局部晚期肺癌在我科接受手术治疗。术中采用心耳钳钳夹左心房壁,在距肿瘤边缘0.5～1cm处切除部分左心房壁,其中5例联合切除部分食管肌层,整块切除肺肿瘤。左心房切缘用3-0无损伤线或4-0普罗纶线连续来回缝合。术前诱导化疗11例,术后化疗23例,其中1例联合放疗。结果术后心律失常3例,其中伴有心肺功能不全1例。无手术死亡,全组病例均治愈出院。术后病理:鳞癌22例,小细胞癌10例,小细胞癌伴鳞癌1例,腺癌3例,腺鳞癌3例,未分类1例。术后1、3、5年生存率分别为80.6%(29/36)、37.0%(10/27)和38.9%(7/18)。结论肺切除加左心房部分切除治疗局部晚期肺癌具有较好的临床疗效,部分病例可因此获得治愈。
Objective To summarize the clinical experience of partial excision of left atrium in the treatment of locally advanced lung cancer. Methods July 1997 ~ August 2008, 40 cases of locally advanced lung cancer involving the left atrium in our department underwent surgical treatment. Intraoperative auricular forceps clamp the left atrial wall, 0.5 ~ 1cm away from the edge of the tumor at the part of the left atrial wall resection, including 5 cases of partial resection of the esophageal muscle layer, the whole removal of the lung tumor. Left atrial margin with 3-0 non-injury line or 4-0 普罗伦 continuous suture back and forth. Preoperative induction chemotherapy in 11 cases, 23 cases of postoperative chemotherapy, including 1 case of combined radiotherapy. Results 3 cases of arrhythmia after operation, of which 1 case of cardiopulmonary dysfunction. No operative death, all patients were cured and discharged. Postoperative pathology: squamous cell carcinoma in 22 cases, 10 cases of small cell carcinoma, small cell carcinoma with squamous cell carcinoma in 1 case, adenocarcinoma in 3 cases, adenosquamous carcinoma in 3 cases, unclassified in 1 case. The 1, 3, 5-year survival rates were 80.6% (29/36), 37.0% (10/27) and 38.9% (7/18), respectively. Conclusions Lung resection plus partial excision of the left atrium for the treatment of locally advanced lung cancer has a good clinical outcome and may be cured in some cases.