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目的 总结 1964例原发性支气管肺癌的外科手术经验。方法 对 1964例肺癌患者 (中心型 114 0例 ,周围型 82 4例 )的临床和病理资料进行回顾性分析。结果 全组手术切除共 162 6例 ,切除率为82 .8% ,其中全肺切除 160例 ,肺叶切除 13 86例 ,支气管袖状成形肺叶切除 70例及支气管楔形成形肺叶切除10例。术后发生并发症 2 94例 ;死亡 2 0例 ,手术死亡率为 1.0 % ( 2 0 /1964 )。对手术中常见的疑难病例处理进行了分析。结论 手术为肺癌的主要治疗方式之一。若遇左上肺癌浸润和包绕左肺动脉干 ,应先阻断肺动脉根部 ,再分离被浸润的上叶肺动、静脉并予结扎切断 ,然后切除有肿瘤的左上叶 ,最后清除血管壁上残余的癌组织。中晚期中心型肺癌以及肺动、静脉根部距肿瘤距离太短 (≤ 0 .5cm)的病例应行心包内结扎肺血管。右上肺癌浸润和包绕上腔静脉和右肺动脉干者可先结扎并切断奇静脉 ,然后轻轻向前外牵拉上腔静脉并小心分离。对肺门冻结者可先处理主支气管 ,然后处理肺动静脉。
Objective To summarize the surgical experience of 1964 patients with primary bronchial lung cancer. Methods The clinical and pathological data of 1964 patients with lung cancer (1140 in central and 824 in peripheral) were retrospectively analyzed. RESULTS: A total of 162 surgical resections were performed in 162 cases. The resection rate was 82.8%, including total pneumonectomy in 160 cases, lobectomy in 1386 cases, bronchial sleeve-shaped lobectomy in 70 cases, and bronchial wedge-shaped lobectomy in 10 cases. Postoperative complications occurred in 2,94 cases; in 20 deaths, operative mortality was 1.0 % (20/1964). Analysis of the treatment of common cases of difficult cases was performed. Conclusion Surgery is one of the main treatments for lung cancer. In case of infiltration of the left upper lung cancer and surrounding the left pulmonary artery, the pulmonary artery root should be blocked first, and then the infiltrated upper lobe lung and veins should be separated and cut off. Then, the upper left lobe of the tumor should be removed, and the residual left of the vessel wall should be removed. Cancer organization. Lung cancer should be ligated within the pericardium in patients with moderately-advanced central lung cancer and pulmonary arterial and venous roots whose distance from the tumor is too short (≤ 0.5 cm). Right upper lung cancer infiltrate and surround the superior vena cava and right pulmonary artery can be ligated and cut off the azygos vein, and then gently pull the superior vena cava and carefully separated. For hilar freezing, the main bronchus can be treated first and then the pulmonary arteries and veins can be treated.