[Lobar bronchoplasty for tumor. Surgical technique and long-term results].
[Lobar bronchoplasty for tumor. Surgical technique and long-term results].
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[肿瘤肺叶支气管成形术。
DOI：
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发表时间：
1995
期刊：
影响因子：
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通讯作者：
E. de Bernardis
中科院分区：
文献类型：
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作者：
G. Motta;M. Nahum;T. Testa;E. Spinelli;A. Gasparo;E. de Bernardis
1978年至1994年，55例患者（53名男性和2名女性），平均年龄为62岁，接受了扩大肺叶切除术的主支气管，支气管再吻合，位于肺叶口周围的支气管肿瘤。32例上叶袖状切除术（58%），1例隆突楔形切除术，7例下单/双叶切除术，上叶“翻起”再吻合术（13%），16例上叶楔形切除术（29%）。鳞状细胞癌占优势（32例，58%），腺癌占16%，腺鳞癌占5%，微小细胞瘤占9%，类癌占4%，高分化神经内分泌癌占2%。当FEV值约为正常值的-25%时，判定为支气管成形术的适应症;在少数仍处于良好呼吸状态的患者中，也接受了择期适应症。术后分期为：1例患者为0期，7例患者为I期; 10例患者为II期; 31例患者为III A期; 5例患者为III B期，1例患者为IV期。完成随访，平均延长40个月（范围3个月-16年）。I期和II期以及III期B和IV期患者无手术死亡率，而III A期患者的手术死亡率为9%。根据分期的生存率如下：I期疾病的5年和10年生存率为66%; II期疾病的5年生存率为56%，10年生存率为45%; III A期疾病的4年生存率为7%。5例III期B患者均未存活18个月以上（平均7个月）。由于其特殊的临床特征，一些单一的生存被提及。除了强调I期和II期疾病获得的生存率的绝对值外，作者还指出这些先进的手术技术在应用于治疗更晚期的III A期疾病时在提高生存时间和生活质量方面的临床作用。
Between 1978 and 1994, 55 patients (53 men and 2 women) with a mean age of 62 years underwent an extended lobectomy to the main bronchus, with bronchial re-anastomosis, for bronchogenic tumours located around the lobar orifice. There were 32 upper sleeve lobectomies (58%) with a wedge resection of carina in one instance, 7 lower mono/bilobectomies with an upper lobe "turn up" re-anastomosis (13%) and 16 upper wedge lobectomies (29%). Squamous cell carcinoma was predominant (32 patients, 58%), while the adenocarcinoma was present in 16%, adenosquamous in 5%, microcitoma in 9%, carcinoid in 4% and a well differentiated neuro-endocrine carcinoma in 2%. The indication for the bronchoplastic procedure was judged to be when the FEV, value was about -25% of the normal; in a few patients still in good respiratory condition, an elective indication was also admitted. Postoperative staging was: Stage 0 in 1 patient, Stage I in 7 patients; Stage II in 10 patients; Stage III A in 31 patients; Stage III B in 5 patients and Stage IV in 1 patient. Follow-up was completed with a mean extension of 40 months (range 3 months-16 years). There was no operative mortality in Stages I and II as well as in Stages III B and IV, while it was 9% in Stage III A patients. Survival rates according to the stage were as following: 66% 5 and 10 year for Stage I disease; 56% 5 year and 45% 10 year for Stage II disease; 7% 4 year for Stage III A. None of 5 patients belonging to Stage III B has survived for more than 18 months (mean 7). Some single survivals are mentioned because of their special clinical features. Besides stressing the absolute value of survival rates obtained in Stage I and II disease, the Author also point out the clinical role of these advanced surgical techniques in improving both the survival length and the quality of life, when applied for the treatment of more advanced Stage III A.