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目的探讨原发性中叶肺癌的临床诊断和外科治疗。方法回顾性分析2003～2007年外科治疗的36例中叶肺癌的临床资料及手术方法。结果行根治性肺叶切除手术34例,其中中叶切除10例,双肺叶切除20例,右全肺切除4例,剖胸探查2例,清扫N1淋巴结108组,N2淋巴结133组,N1阳性5例,N2阳性1例,N1+N2阳性7例,Ⅰ期5例,Ⅱ期11例,ⅢA期15例,ⅢB期2例,Ⅳ期1例。病理类型以腺癌居多,术后20例行化疗。手术无死亡病例,1年、3年、5年生存率分别为83.3%、52.7%、38.8%。结论中叶肺癌发病率较低,易误诊和延误诊断,需与中叶肺良性病变相鉴别,治疗以根治性肺叶切除为主,由于解剖特点,需行中上叶或中下叶切除,清扫上下纵膈淋巴结是手术根治的关键。
Objective To investigate the clinical diagnosis and surgical treatment of primary middle lung cancer. Methods The clinical data and surgical methods of 36 cases of middle lung cancer surgically treated from 2003 to 2007 were analyzed retrospectively. Results There were 34 cases of radical lobectomy, including 10 cases of middle lobectomy, 20 cases of double lobe resection, 4 cases of right pneumonectomy, 2 cases of exploratory chest dissection, 108 cases of N1 lymph node dissection, N2 lymph node group of 133 and N1 positive of 5 cases , N2 positive in 1 case, N1 + N2 positive in 7 cases, stage Ⅰ in 5 cases, stage Ⅱ in 11 cases, stage ⅢA in 15 cases, stage ⅢB in 2 cases and stage Ⅳ in 1 case. The majority of pathological types of adenocarcinoma, 20 cases of postoperative chemotherapy. No deaths were found in the cases. The 1-year, 3-year and 5-year survival rates were 83.3%, 52.7% and 38.8% respectively. Conclusions The incidence of mid-lobe lung cancer is low, misdiagnosis and delaying diagnosis are needed, so it should be differentiated from benign lung disease in middle lobe. The treatment is mainly based on radical lobectomy. Due to anatomical features, middle and upper lobe or middle and lower lobe resection is needed, Diaphragmatic lymph nodes is the key to radical surgery.