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目的 探讨以手术为主的综合疗法对小细胞肺癌的临床治疗效果。方法 回顾性分析 84 5例小细胞肺癌临床资料 :其中 5 73例广泛期病变均采用化疗或放疗 ;局限期病变 2 72例 :化疗或 /和放疗 5 0例 ;手术 +术后化疗 4 8例 ;术前化疗 +手术 +术后化疗或 /和放疗 174例 ;比较分析、评价不同方法的疗效。结果 广泛期病变 1、2、3年存活率分别为 13%、6 .8%、0 % ;局限期病变 :化疗组和术后化疗组 1、3、5年存活率分别为 74 .2 %、31.2 %、4 .3%和 87.5 %、4 6 .6 %、31.9% ,二组间 1年存活率无显著差异 (P >0 .0 5 ) ,3、5年的存活率差异显著 (P <0 .0 5 ) ;而术前先化疗、后手术 ,术式包括肺叶切除、全肺切除、支气管 /肺动脉袖式切除重建 ,术后再化疗 /放疗的 174例 ,其 1、3、5、10年存活率分别为 88.4 % ,5 8.9% ,4 9.5 % ,11.5 %。颅内、肝脏和骨髓广泛转移为影响长期存活的主要原因。结论 小细胞肺癌对化疗和放疗均敏感 ,广泛期病变已无手术适应症 ,应采用以化疗 /放疗为主的保守治疗。而局限期小细胞肺癌则应选择以手术为主、辅以术前、术后化疗 /放疗的综合方法 ,可获得较为满意、甚至长期存活的临床效果
Objective To investigate the clinical effect of surgery-based comprehensive therapy on small cell lung cancer. Methods A retrospective analysis of 84 5 cases of small cell lung cancer clinical data: of which 5 73 cases of extensive disease were treated with chemotherapy or radiotherapy; local disease 727 cases: chemotherapy or / and radiation 50 cases; surgery + postoperative chemotherapy 48 cases ; Preoperative chemotherapy + surgery + postoperative chemotherapy or / and radiotherapy 174 cases; comparative analysis to evaluate the efficacy of different methods. Results The survival rates at 1, 2 and 3 years of extensive disease were 13%, 6.8% and 0%, respectively. The local lesion: The survival rates at 1, 3 and 5 years of chemotherapy group and postoperative chemotherapy group were 74.2% , 31.2%, 4.3% and 87.5%, 46.6% and 31.9% respectively. There was no significant difference in one-year survival rates between the two groups (P> 0.05) P <0.05). However, preoperative chemotherapy and postoperative operation included 174 cases with lobectomy, pneumonectomy, bronchial / pulmonary sleeve resection and reconstruction, and postoperative chemotherapy / The 5-year and 10-year survival rates were 88.4%, 59.9%, 4 9.5% and 11.5% respectively. Extensive intracranial, hepatic and myeloid metastases are the major causes of long-term survival. Conclusions Small cell lung cancer is sensitive to both chemotherapy and radiotherapy. There is no surgical indication for extensive disease. Conservative treatment with chemotherapy / radiotherapy should be adopted. The limited period of small cell lung cancer should be based on surgery should be selected, combined with preoperative and postoperative chemotherapy / radiotherapy comprehensive approach to obtain more satisfactory, or even long-term survival of the clinical effect