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[目的]探讨肺癌伴胸膜转移恶性胸水行胸膜全肺切除术手术技术和术中处理体会。[方法]1988年1月至2003年1月对21例肺癌伴胸膜转移恶性胸水患者行胸膜全肺切除术。肺部原发病灶位于左肺8例,右肺13例。其中鳞癌1例,腺癌12例,腺鳞癌2例,肺泡细胞癌6例。采用胸膜外径路整块切除病变,低能混切电刀分离壁层胸膜,尤其注重心包、纵隔大血管表面胸膜、膈胸膜的切除;对确无法彻底切除的少量残余癌灶,局部反复电刀烧灼;心包表面有转移病灶未行心包切除者常规行心包开窗;关胸前以大量蒸馏水反复冲洗胸腔及切口,氮芥留置胸腔。[结果]无围手术期死亡,无支气管胸膜瘘、脓胸、大出血等严重并发症。随访已死亡16例,生存期为5￣34个月,其余5例患者随访24￣29个月仍生存,全组中位生存时间18个月,死亡原因均为远处转移,无局部肿瘤复发。[结论]Ⅲb期肺癌病人有选择地行胸膜全肺切除术是安全可行的,改良手术技术可以减少手术并发症、降低肿瘤局部复发机会,采用该术式再结合综合治疗,能获得明显延长生存时间的良好效果。
[Objective] To investigate the surgical technique and intraoperative management of pleural pneumonectomy in patients with lung cancer with malignant pleural effusion and pleural metastasis. [Method] From January 1988 to January 2003, 21 cases of pleural pneumonectomy were performed in 21 patients with lung cancer with pleural metastasis. Pulmonary primary lesions in the left lung in 8 cases, 13 cases of right lung. One case of squamous cell carcinoma, adenocarcinoma in 12 cases, adenosquamous carcinoma in 2 cases, alveolar cell carcinoma in 6 cases. Removal of lesions using the pleural diameter of the whole block, low-energy hybrid electric knife separation parietal pleura, with particular attention to the pericardial, mediastinal surface of the large vessels of the pleura, diaphragm pleural resection; indeed can not completely remove a small amount of residual foci, repeated local electric knife burning ; The surface of the pericardial metastatic lesions were not undergone pericardial routine pericardial fenestration; off the chest with plenty of distilled water repeatedly washed thoracic and incision, nitrogen musty thoracic cavity. [Results] No perioperative death, no bronchopleural fistula, empyema, severe bleeding and other serious complications. Follow-up has been 16 cases of death, the survival of 5 to 34 months, the remaining 5 patients were followed up for 24 to 29 months, the median survival time of 18 months, the cause of death were distant metastasis, no local tumor recurrence . [Conclusion] Selective pneumonectomy of pleural pneumonectomy is safe and feasible in stage Ⅲb patients with lung cancer. Improved surgical techniques can reduce surgical complications and reduce the chance of local tumor recurrence. By using this technique in combination with comprehensive treatment, patients with significantly prolonged survival can be obtained Good effect of time.