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目的:探索以手术为主的综合疗法对小细胞肺癌的适应症,方法及临床效果。方法:回顾性总结分析845例小细胞肺癌治疗的临床资料:其中573例广泛期病变采用化疗或(和)放疗;局限期病变272例:单纯化(放)疗50例;先手术后化疗48例;先化疗后手术再化或(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年生存率分别为13.0%、6.8%、0;局限期病变:化疗组和手术后化疗组1、3、5年生存率分别为74.2%、31.2%、4.3%和75%、46.6%、31.9%,二组间1年生存率无显著性差异(P>0.05),3、5年的生存率差异显著(P<0.05);而先化疗、后手术、术后化(放)疗组1、3、5、10年生存率分别为88.4%、58.9%、46.5%、11.5%,明显优于前两组(P<0.05);术前所用化疗方案与周期对生存时间无明显影响。术式包括肺叶切除、全肺切除、支气管(肺动脉)袖式切除重建,肺叶和全肺切除的5、10年生存率明显优于袖式切除,肺叶切除优于全肺及袖式切除。颅内、肝脏或骨髓转移仍为影响本组小细胞肺癌长期生存的主要原因。结论:小细胞肺癌对化疗、放疗均敏感,广泛期病变无手术适应症,应采用以化(放)疗为主的保守治疗。而局限期小细胞肺癌则应积极选用以手术为主、辅助术前、术后化(放)疗的综合方法,可获得较为满意、甚至长期生存的临床效果。
Objective: To explore the surgical treatment of small cell lung cancer indications, methods and clinical effects. Methods: A retrospective analysis of 845 cases of small cell lung cancer clinical data: of which 573 cases of extensive disease using chemotherapy or (and) radiotherapy; local disease 272 cases: simple (radiotherapy) in 50 cases; first after chemotherapy 48 For example, the first chemotherapy after re-or (and) radiotherapy in 174 cases; comparative analysis to evaluate the efficacy of different methods. Results: The 1-, 2-, 3- year survival rates of extensive-stage disease were 13.0%, 6.8%, 0 respectively. The survival rates of the one-year, three-year, and the five-year survival in chemotherapy group and postoperative chemotherapy group were 74.2%, 31.2% 4.3% and 75%, 46.6% and 31.9% respectively. There was no significant difference in one-year survival rate between the two groups (P> 0.05) The survival rates at 1, 3, 5 and 10 years postoperatively were 88.4%, 58.9%, 46.5% and 11.5% respectively, which were significantly better than those of the former two groups (P <0.05). The chemotherapy regimen And the cycle had no significant effect on the survival time. Surgery, including lobectomy, pneumonectomy, bronchial (pulmonary) sleeve resection and reconstruction, lung and pneumonectomy 5-10 years survival rate was significantly better than the sleeve resection, lobectomy is better than the whole lung and sleeve resection. Intracranial, liver or bone marrow metastasis is still the main reason for the long-term survival of this group of small cell lung cancer. CONCLUSIONS: Small-cell lung cancer is sensitive to chemotherapy and radiotherapy. There are no indications for surgery in extensive stage of disease. Conservative treatment with chemotherapy should be used. The limited period of small cell lung cancer should be actively selected mainly by surgery, assisted preoperative and postoperative (radiotherapy) comprehensive approach to obtain more satisfactory, or even the clinical effect of long-term survival.