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目的分析探讨肺癌累及上腔静脉行手术切除的可行性及价值。方法回顾性分析1988年3月—2005年4月的31例肺癌累及上腔静脉手术治疗患者的临床资料,其中鳞癌17例、腺癌8例、小细胞未分化癌6例;N0,1期12例,N2期19例;T4期22例,T2,3期9例。采用上腔静脉切除人工血管置换(18例),侧壁切除自体心包片修补(8例)、直接缝合(5例)的方法处理切除后的上腔静脉,统计围手术期并发症及长期生存率,分析生存及预后情况。结果18例上腔静脉置换者中,上腔静脉阻断者17例,阻断时间8~35min;13例上腔静脉部分切除修补者,9例阻断上腔静脉,阻断时间3~15min。无手术死亡,术后并发症发生率为48%(15/31)。术后随访28例,时间3~130个月,总的中位生存期为31个月,1,3和5年生存率分别为61%,33%和21%,其中N0,1期、N2期患者的中位生存期分别为42和13个月(χ2=14.3,P=0.000);病理类型及手术方式对预后无影响;术前及术中化学治疗(化疗)的患者预后好于术前及术中未化疗者,中位生存期分别为39和14个月(χ2=5.0,P=0.025)。结论肺癌累及上腔静脉进行手术治疗可行,无纵隔淋巴结转移者预后较好,应尽可能手术治疗;术前或术中化疗值得推荐。
Objective To investigate the feasibility and value of surgically resected superior vena cava in lung cancer. Methods The clinical data of 31 patients with lung cancer involving the superior vena cava were retrospectively analyzed from March 1988 to April 2005, including 17 cases of squamous cell carcinoma, 8 cases of adenocarcinoma and 6 cases of small cell undifferentiated carcinoma. 12 cases, N2 in 19 cases; T4 in 22 cases, T2, 9 cases. The superior vena cava was treated with superior vena cava resection (18 cases), lateral resection with autologous pericardium (8 cases) and direct suture (5 cases). The perioperative complications and long-term survival Rate, analysis of survival and prognosis. Results Among the 18 cases of superior vena cava replacement, 17 cases of superior vena cava occlusion were interrupted for 8 to 35 minutes. Thirteen cases of superior vena cava partial resection and repair, 9 cases of superior vena cava occlusion and 3-15 minutes of blockade . No surgical death, the incidence of postoperative complications was 48% (15/31). Postoperatively, 28 patients were followed up for 3 to 130 months with a median overall survival of 31 months. The 1, 3, and 5-year survival rates were 61%, 33%, and 21%, respectively. The median survival was 42 and 13 months, respectively (χ2 = 14.3, P = 0.000). The pathological types and surgical modalities had no effect on prognosis. The prognosis of patients undergoing preoperative and intraoperative chemotherapy (chemotherapy) was better than that of surgery The median survival was 39 and 14 months, respectively, before and during chemotherapy (χ2 = 5.0, P = 0.025). Conclusion It is feasible to involve the superior vena cava in surgical treatment of lung cancer. The prognosis of patients without mediastinal lymph node metastasis is better. Surgical treatment should be performed as far as possible. Preoperative or intraoperative chemotherapy is recommended.