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目的 总结已有外侵的巨大肺癌肿块 (T3～ 4)及纵隔淋巴结阳性 (N2 )的手术切除经验 ,观察远期疗效 ,分析临床意义。 方法 131例T3～ 4N2M0期肺癌肺叶切除时 ,分别扩大切除外侵组织 ,切除一侧整个纵隔胸膜及脂肪 ,广泛清扫纵隔内淋巴结。 结果 肿瘤切除后打破了机体的免疫封闭状态 ,3年生存率鳞癌达 34 0 % ,腺癌为 18 0 %。综合治疗组与单纯手术组相比 ,3,5年生存率均较低 ,差异无显著性 (P >0 0 5 )。纵隔淋巴结阳性的T3～ 4期肿瘤扩大切除广泛淋巴结清扫后再行综合治疗 ,效果不佳。 结论 扩大切除加广泛淋巴结清扫治疗T3～ 4N2M0期肺癌降低了手术探查率 ,提高了手术切除率 ,但扩大手术指征仍需谨慎选择。
Objective To summarize the surgical resection experience of large invasive lung cancer masses (T3～4) and mediastinal lymph node positive (N2), and to observe the long-term curative effect and analyze the clinical significance. Methods Thirty-one patients with T3～4N2M0 lung cancer underwent extensive resection of the invading tissue and excision of one mediastinal pleura and adipose tissue, and extensively cleaned the mediastinal lymph nodes. Results After the resection of the tumor, the body’s immuno-enclosed state was broken. The three-year survival rate was 34% for squamous cell carcinoma and 18% for adenocarcinoma. Compared with the surgery alone group, the 3-year and 5-year survival rates were lower in the comprehensive treatment group and the difference was not significant (P > 0 05). Mediastinal lymph node positive T3 ~ 4 tumors were extensively resected and extensive lymphadenectomy followed by comprehensive treatment was ineffective. Conclusion Extended resection combined with extensive lymph node dissection for the treatment of T3～4N2M0 lung cancer reduces the surgical exploration rate and improves the surgical resection rate. However, the indications for expanding the surgical operation still need to be carefully selected.