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目的 探讨晚期支气管肺癌侵犯不同部位的外科处理方法。方法 隆突切除重建６ 例、支气管肺叶肺动脉双袖切除重建１８例、支气管肺叶袖状切除重建３８例（含隆突切除重建３ 例）、心包内肺切除 ５２例、胸膜全肺切除 ２８例。结果 全组无手术死亡，未发生吻合口瘘，无其他严重并发症发生。随访：隆突切除重建１例术后１４６ｄ因肺部感染呼吸衰竭死亡，其余５例术后生存最长已超过３年，最短为１．５年。１、３、５年生存率分别是：支气管肺动脉双袖状切除重建９４．４％、４４．４％、２７．８％，支气管肺叶袖状切除重建９７．４％、５２．６％、３４．２％，心包内肺切除８０．８％、２６．９％、１５．４％。胸膜全肺切除平均存活期１８个月，中位生存期１７个月，水胸、胸痛及上腹痛未复发。结论 采用不同的手术方法，治疗晚期肺癌，符合肺癌手术的“两个最大限度”原则，可扩大肺癌的手术指征，减少开胸探查率，提高病人生活质量，为晚期肺癌病人提供多学科综合治疗创造了条件。
Objective To investigate the surgical treatment of advanced bronchial carcinoma in different parts of invasion. Methods Six cases underwent resection and reconstruction of the carina by pulmonary embolization, 18 cases underwent double sleeve resection and reconstruction of bronchial lobular pulmonary artery, 38 cases underwent sleeve resection and bronchial lobectomy (including 3 cases with excision and reconstruction), 52 cases underwent pericardial pneumonectomy and 28 cases underwent pleural pneumonectomy. Results The whole group had no operative death, no anastomotic fistula occurred and no other serious complications occurred. Follow-up: One case of resection and reconstruction of the carina was died of respiratory failure due to pulmonary infection 146 days after operation. The remaining 5 cases had the longest survival after 3 years and the shortest was 1.5 years. The 1, 3, 5-year survival rates were 94.4%, 44.4%, 27.8% in the double sleeve resection of bronchopulmonary artery and 97.4%, 52.6% in sleeve resection of bronchial lobe .2%, pneumonectomy in the pericardium 80.8%, 26.9%, 15.4%. Pleural pneumonectomy average survival of 18 months, the median survival of 17 months, water chest, chest pain and abdominal pain did not relapse. Conclusions The different operation methods and treatment of advanced lung cancer meet the “two maximum” principle of lung cancer surgery, which can expand the operation indications of lung cancer, reduce the detection rate of thoracotomy, improve the quality of life of patients and provide multidisciplinary comprehensive treatment for patients with advanced lung cancer Treatment created the conditions.