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1993年7月~1997年5月间,在17例肺癌患者手术中进行了肺动脉切除和重建。肺动脉袖状切除12例,侧壁切除5例。同时作总支气管袖状切除10例,楔形切除2例,残端成形1例,上叶支气管移位吻合2例。1例双袖状右上中联合肺叶切除后,又切断下肺静脉。下叶肺置于肝素溶液中(12500U/500mlNS),15min后将下肺静脉移植于上叶静脉残端,再作支气管、肺动脉吻合。随访1~44个月,无手术近期死亡。术后13个月死于心肺衰竭1例,12、17、18、19个月各有1例死于肿瘤复发,余12例生存良好,最长存活44个月。作者认为当肿瘤或(及)肿大淋巴结环绕肺动脉或其分支起始部时,则应行肺动脉切除和重建,其必要性和可行性均在术中确定。双袖状右上中肺联合肺叶切除术中,当总支气管或肺动脉切除过长时可将下肺静脉移植于上肺静脉残端以缓解吻合口张力,作者主张围手术期应行抗凝治疗。
From July 1993 to May 1997, pulmonary artery resection and reconstruction were performed in 17 patients with lung cancer. Pulmonary artery sleeve resection in 12 cases, lateral resection in 5 cases. At the same time for the total bronchial sleeve resection in 10 cases, wedge resection in 2 cases, stump formation in 1 case, upper lobe bronchial anastomosis in 2 cases. One case of double-sleeve right upper middle lobe resection, and cut off the lower pulmonary vein. The lower lobe placed in heparin solution (12500U / 500mlNS), 15min after the inferior pulmonary vein graft in the upper veins stump, and then for the bronchus, pulmonary anastomosis. Follow-up 1 to 44 months, no recent surgical death. One patient died of cardiorespiratory failure at 13 months after operation, one patient died of tumor recurrence at 12, 17, 18 and 19 months, and the remaining 12 patients survived with a maximum survival of 44 months. The authors believe that when the tumor or (and) enlarged lymph nodes around the pulmonary artery or the beginning of its branches, pulmonary artery resection and reconstruction should be performed, the necessity and feasibility of the surgery were identified. Double-sleeve right upper middle lung combined with lobectomy, when the total bronchial or pulmonary artery resection is too long, the lower pulmonary vein can be implanted in the stump of the pulmonary veins to relieve anastomotic tension, the author claims perioperative anticoagulant therapy.