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目的 探讨应用自体肺移植技术治疗上叶中心型肺癌的可行性。 方法 2例作双袖状右上中叶联合肺叶切除 ,因支气管切除过长或肺动脉切除过长 ,吻合张力过大 ,做下肺静脉切断 ,肺短时间离体后作下叶重植 ,将下肺静脉移植于上肺静脉残端。 2例左上叶肺癌部分侵及斜裂 ,无法进行双袖状肺叶切除术 ,行全肺切除后 ,在器械台上行肿瘤切除 ,下叶修剪后重植于胸腔内。 结果 随访至 1999年 12月 ,第 1、3、4例患者已分别无瘤存活 31、18和 13个月。第 1和 3例患者生活质量良好 ,但第 4例患者活动能力极差。第4例术后 42d因肺动脉、支气管胸膜瘘 ,做移植肺切除。第 2例术后 19d死于支气管胸膜瘘、张力性气胸。 结论 对心肺功能不能耐受全肺切除的III期上叶中心型肺癌患者 ,自体肺移植是一种可供选择的能保全肺组织的肺癌根治术式
Objective To investigate the feasibility of using autologous lung transplantation to treat central lobe lung cancer. Methods Two cases of double-sleeved right upper lobe combined with lobectomy were performed because the bronchial resection was too long or the pulmonary artery resection was too long. The anastomosis tension was too large. The inferior pulmonary veins were cut off. The lungs were replanted after a short time in vitro, and the inferior pulmonary veins were transplanted onto the Pulmonary vein stump. Two patients with left upper lobe had invasive and oblique fissures and could not undergo double-sleeved lobectomy. After pneumonectomy, tumors were removed on the instrument table and replanted in the chest after pruning. Results Follow-up to December 1999, the first, third, and fourth patients had no tumor survival 31, 18, and 13 months, respectively. The first and third patients had good quality of life, but the fourth patient had very poor mobility. In the 4th case, the pulmonary artery and bronchial pleural fistula were performed 42d after the operation for transplant lung resection. The second case died of bronchopleural fistula and tension pneumothorax at 19 days after operation. Conclusion Autologous lung transplantation is an alternative lung cancer radical resection technique for patients with stage III upper lobe central lung cancer who cannot tolerate pneumonitis due to pneumonectomy.