胸膜全肺切除治疗肺癌胸膜转移伴恶性胸腔积液VIP免费

#临床研究#胸膜全肺切除治疗肺癌胸膜转移伴恶性胸腔积液周乃康梁朝阳张竞刘阳初向阳孙玉鹗黄孝迈=摘要>背景与目的按肺癌TNM国际分期标准,肺癌胸膜转移伴癌性胸水属于ÓB期,既往一般采取非手术疗法,但疗效较差,患者的生活质量不高。本研究通过观察胸膜全肺切除的临床应用,来评估治疗ÓB期肺癌伴胸膜转移和癌性胸水的注意事项和远期效果。方法对1978年12月至2003年2月间采用该术式治疗的55例肺癌伴有胸膜转移、癌性胸水的患者进行总结,定期随访,了解患者生活质量、复发情况和生存时间。计算术后生存率和中位生存时间。结果本组患者中手术死亡2例。患者术后胸闷、呼吸困难、胸腹壁疼痛症状明显缓解,恶病质迅速消失,未见胸水复发,但后期绝大部分患者发生远处脏器转移。随访至2003年8月,出院患者中已死亡48例,生存时间5~40月,平均生存期15个月,中位生存期14个月,仍健在的5例患者术后时间均未超过1年。结论¹要严格掌握手术适应证;º手术中要注意肿瘤切除的彻底性;»术中要重视对切口的保护;¼手术打破免疫封闭状态,为后续治疗创造条件;½患者通过手术可以提高生活质量和中位生存期;¾患者术后远期生存还不尽如人意。=关键词>肺肿瘤胸膜胸水胸膜全肺切除=中图分类号>R734.2Pleuro-pneumonectomyinthetreatmentofpulmonarycarcinomacomplicatedwithdiffusepleuralmetastasisandmalignantpleuraleffusionZHOUNaikang,LIANGChaoyang,ZHANGJing,LIUYang,CHUXiang-yang,SUNYu.e,HUANGXiaomai.DepartmentofThoracicSurgery,GeneralHospitalofPLA,Bei-jing100853,P.R.ChinaCorrespondingauthor:ZHOUNaikang,E-mail:znkljp@sina.com=Abstract>BackgroundandobjectiveAccordingtotheinternationalstandardinTNMstagingofpulmo-narycarcinoma,pulmonarycarcinomacomplicatedwithdiffusepleuralmetastasisandmalignantpleuraleffu-sionbelongstoÓBstage.Inthepast,non-operativetherapywasemployed,butboththetherapeuticefficacyandthequalityoflifeofpatientswerepoor.Thepurposeofthisstudyistofindoutacomplextreatmentforthisdisease.MethodsTotalpleuro-pneumonectomywasperformedin55casesofpatientswithpulmonarycarcinomacomplicatedwithdiffusepleuralmetastasisandmalignantpleuraleffusionfromDecember1978toFebruary2003.Thepatientswerefolloweduppostoperatively,andthequalityoflifeandsurvivalperiodofthemwereobserved.ResultsInallthecases,only2patientsdiedofoperation.Satisfactoryrecoveryandre-markablereliefofsymptomssuchasshortbreath,dyspneaandchestpainwerefoundinalltheotherpatients.Afterafollow-upperiodof1--25years,localrecurrencewasfoundin6cases(11.3%),anddistantmetastasisin42cases(79.2%).Atotalof48patientsdiedoftumor,withsurvivalperiodrangingfrom5--40months(averagesurvivalperiod:15months;mediansurvivalperiod:14months),and5patientswerestillaliveingoodhealth.Conclusion¹Patientsappropriatedforoperationshouldbecarefullyselectedincasethatpost-operativecomplicationsinfluencetheirsmoothrecovery;ºTumortissuesshouldberemovedasclearasposs-ible;»Duringtheoperation,closeattentionshouldbepaidtotheprotectionofincisions;¼Removalofthetumortissuescanreducethetumorload,effectivelycleantheimmunosuppressivefactorsinmalignantpleuraleffusion,andbreaktheimmunityblockstatus,whichprovidesbasisforthefollowingcomprehensivetherapy;½Thequalityoflifeofthepatientscanbeimprovedandthemediansurvivalperiodcanbeprolongedbytheoperation;¾Thelong-termsurvivalrateofpatientsisstillunsatisfactory.=Keywords>LungneoplasmsPleuraPleuraleffusionPleuro-pneumonectomy作者单位:100853北京,解放军总医院胸外科(通讯作者:周乃康,E-mail:znkljp@sina.com)#465#中国肺癌杂志2005年10月第8卷第5期ChinJLungCancer,October2005,Vol.8,No.5肺癌胸膜转移伴癌性胸水,按肺癌TNM国际分期标准属于ÓB期,既往一般采取非手术疗...