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目的 总结肺动脉切除重建术在肺癌外科治疗中应用的经验。方法 对 36例中心型肺癌侵犯肺动脉的病人行肺动脉切除重建术。重建术采用自体心包移植补片 5例、奇静脉移植补片 3例、心包管间位移植 2例 ,肺动脉袖式切除 9例 ,侧壁切除 17例 ;同时支气管袖式切除 30例 ,肺叶切除 6例。术后辅助放疗 14例 ,化疗 12例。结果 术后 1例支气管吻合口瘘者死亡 ,余者肺通气及灌注良好。术后 1、3和 5年生存率分别为 82 9%、48 1%和 35 3%。结论 应用自体心包、奇静脉移植及直接肺动脉重建术治疗中心型肺癌是一种安全、有效、可行的术式 ,能扩大手术适应证 ,彻底切除肿瘤 ,保存肺功能 ,疗效满意。
Objective To summarize the experience of pulmonary artery resection and reconstruction in the surgical treatment of lung cancer. Methods Pulmonary resection was performed in 36 patients with central lung cancer that invaded the pulmonary artery. Reconstruction was performed using autologous pericardial transplantation in 5 cases, azygote transplantation in 3 cases, pericardial transposition in 2 cases, pulmonary artery sleeve removal in 9 cases, and lateral wall resection in 17 cases; simultaneous bronchial sleeve resection in 30 cases, lobectomy 6 cases. Postoperative adjuvant radiotherapy in 14 cases, chemotherapy in 12 cases. Results One patient died of bronchial anastomotic fistula after operation. The rest had good ventilation and perfusion. The 1-, 3-, and 5-year survival rates after surgery were 82 9%, 48 1%, and 35 3%, respectively. Conclusion The use of autologous pericardial, azygous vein grafting and direct pulmonary artery reconstruction for the treatment of central lung cancer is a safe, effective and feasible surgical procedure. It can expand the surgical indications, completely remove the tumor and preserve the lung function. The results are satisfactory.