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1、中國肺癌雜志2005年10月第8卷第5期ChinJLungCancer,October2005,Vol.8,No.5#465##臨床研究#胸膜全肺切除治療肺癌胸膜轉(zhuǎn)移伴惡性胸腔積液周乃康梁朝陽張競(jìng)劉陽初向陽孫玉鶚黃孝邁=摘要>背景與目的按肺癌TNM國際分期標(biāo)準(zhǔn),肺癌胸膜轉(zhuǎn)移伴癌性胸水屬于óB期,既往一般采取非手術(shù)療法,但療效較差,患者的生活質(zhì)量不高。本研究通過觀察胸膜全肺切除的臨床應(yīng)用,來評(píng)估治療óB期肺癌伴胸膜轉(zhuǎn)移和癌性胸水的注意事項(xiàng)和遠(yuǎn)期效果。方法對(duì)1978年12月至2003年2月間采用該術(shù)式治療的55例肺癌伴有胸膜轉(zhuǎn)移、癌性胸水的患者進(jìn)行總結(jié),定期隨訪,了解患者生活質(zhì)
2、量、復(fù)發(fā)情況和生存時(shí)間。計(jì)算術(shù)后生存率和中位生存時(shí)間。結(jié)果本組患者中手術(shù)死亡2例?；颊咝g(shù)后胸悶、呼吸困難、胸腹壁疼痛癥狀明顯緩解,惡病質(zhì)迅速消失,未見胸水復(fù)發(fā),但后期絕大部分患者發(fā)生遠(yuǎn)處臟器轉(zhuǎn)移。隨訪至2003年8月,出院患者中已死亡48例,生存時(shí)間5~40月,平均生存期15個(gè)月,中位生存期14個(gè)月,仍健在的5例患者術(shù)后時(shí)間均未超過1年。結(jié)論1要嚴(yán)格掌握手術(shù)適應(yīng)證;o手術(shù)中要注意腫瘤切除的徹底性;?術(shù)中要重視對(duì)切口的保護(hù);?手術(shù)打破免疫封閉狀態(tài),為后續(xù)治療創(chuàng)造條件;?患者通過手術(shù)可以提高生活質(zhì)量和中位生存期;?患者術(shù)后遠(yuǎn)期生存還不盡如人意。=關(guān)鍵詞>肺腫瘤胸膜胸水胸膜全肺切
3、除=中圖分類號(hào)>R734.2Pleuro-pneumonectomyinthetreatmentofpulmonarycarcinomacomplicatedwithdiffusepleuralmetastasisandmalignantpleuraleffusionZHOUNaikang,LIANGChaoyang,ZHANGJing,LIUYang,CHUXiang-yang,SUNYu.e,HUANGXiaomai.DepartmentofThoracicSurgery,GeneralHospitalofPLA,Bei-jing100853,P.R.ChinaCorr
4、espondingauthor:ZHOUNaikang,E-mail:znkljp@sina.com=Abstract>BackgroundandobjectiveAccordingtotheinternationalstandardinTNMstagingofpulmo-narycarcinoma,pulmonarycarcinomacomplicatedwithdiffusepleuralmetastasisandmalignantpleuraleffu-sionbelongstoóBstage.Inthepast,non-operativetherapywasempl
5、oyed,butboththetherapeuticefficacyandthequalityoflifeofpatientswerepoor.Thepurposeofthisstudyistofindoutacomplextreatmentforthisdisease.MethodsTotalpleuro-pneumonectomywasperformedin55casesofpatientswithpulmonarycarcinomacomplicatedwithdiffusepleuralmetastasisandmalignantpleuraleffusionfro
6、mDecember1978toFebruary2003.Thepatientswerefolloweduppostoperatively,andthequalityoflifeandsurvivalperiodofthemwereobserved.ResultsInallthecases,only2patientsdiedofoperation.Satisfactoryrecoveryandre-markablereliefofsymptomssuchasshortbreath,dyspneaandchestpainwerefoundinalltheotherpatient
7、s.Afterafollow-upperiodof1--25years,localrecurrencewasfoundin6cases(11.3%),anddistantmetastasisin42cases(79.2%).Atotalof48patientsdiedoftumor,withsurvivalperiodrangingfrom5--40months(averagesurvivalperiod:15months;mediansurvivalperiod:14months),and5patientswer
