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目的总结侵犯大血管和左心房的局部晚期非小细胞肺癌的外科治疗经验。方法回顾性分析我科2005年2月至2009年11月期间对32例局部晚期(T4N0M0、T4N1M0、T4N2M0)非小细胞肺癌患者(男27例,女5例;年龄48~73岁,中位年龄58岁)采用原发肿瘤加部分心房或大血管切除治疗的临床资料。侵犯上腔静脉和无名静脉5例,肺动脉干4例,左心房23例。行左全肺及左心房部分切除13例,左全肺及肺动脉干部分切除4例,右全肺及左心房部分切除9例(其中2例在体外循环辅助下进行),右肺中下叶及部分左心房切除1例,右肺上叶及上腔静脉部分切除人工血管置换3例,上腔静脉修补2例。结果本组32例患者无手术死亡,手术完全切除16例。术后仅有3例发生心律失常。肿瘤病理类型:鳞癌25例,腺癌5例,大细胞癌2例。术后pTNM分期:T4N0M03例,T4N1M011例,T4N2M018例。所有患者术后随访6个月~5年,中位生存时间15个月;T4N0M0、T4N1M0患者的中位生存时间为19个月,T4N2M0患者的中位生存时间为10个月。1例患者无瘤生存5年。结论侵及心房大血管的局部晚期肺癌(Ⅲb期)采用扩大切除术能提高根治性手术切除率,改善患者生活质量,提高局部晚期肺癌患者的生存率。
Objective To summarize the experience of surgical treatment of locally advanced non-small cell lung cancer that invading the large vessels and the left atrium. Methods A retrospective analysis of 32 patients with locally advanced (T4N0M0, T4N1M0, T4N2M0) non-small cell lung cancer (27 males and 5 females; aged 48-73 years, median age from February 2005 to November 2009) Age 58 years) using the primary tumor plus partial atrial or macrovascular resection of the clinical data. Invaded the superior vena cava and anonymous vein in 5 cases, pulmonary artery in 4 cases, 23 cases of left atrium. Left lung and left atrium partial resection in 13 cases, left lung and pulmonary artery partial resection in 4 cases, right lung and left atrium partial resection in 9 cases (2 cases under the help of cardiopulmonary bypass), lower right middle lobe And partial left atrial resection in 1 case, the right upper lobe and superior vena cava were partially resected in 3 cases of artificial vascular replacement, superior vena cava repair in 2 cases. Results 32 patients in this group were operated without surgery, 16 cases were completely resected. Only 3 cases had arrhythmia after operation. Tumor pathological types: 25 cases of squamous cell carcinoma, 5 cases of adenocarcinoma, 2 cases of large cell carcinoma. Postoperative pTNM staging: T4N0M03 cases, T4N1M011 cases, T4N2M018 cases. All patients were followed up for 6 months to 5 years with a median survival time of 15 months. The median survival time of patients with T4N0M0 and T4N1M0 was 19 months, and the median survival time of patients with T4N2M0 was 10 months. One patient survived 5 years without tumor. Conclusion Extended partial neoplasm of advanced lung cancer (Ⅲb) invading the atria and large vessels can increase the radical resection rate, improve the quality of life and increase the survival rate of patients with locally advanced lung cancer.