作者：ZHANG Lin-you 张临友 LI Gang 李刚 TAN Pei-lin 谭佩林
单位：LI Gang 李刚(Department of Thoracic Surgery,The Second Affiliated Hospital,Harbin Medical University,Harbin 150086,China) ； TAN Pei-lin 谭佩林(Department of Thoracic Surgery,The Second Affiliated Hospital,Harbin Medical University,Harbin 150086,China)
关键词：
哈尔滨医科大学学报000134 Key words：lung cancer;left atrium;pneumonectomy▲
The number of patients with lung cancer is increasing rapidly,cancers involving the lung are best treated by complete,en bloc resection.When they extend into the left atrium,lung cancers are recognized to be inoperable.Introduction of the techniques of cardiovascular surgery has made possible en bloc resection of the lung with part of the involved left atrium.
From May 1990 to September 1998,9 patients with lung cancer involving left atrium were surgically treated in our hospital.There were 7 male and 2 female patients ranging in age from 33 to 65 years.Pulmonary cancers extending into the left atrium require careful planning before resection.Preoperative investigation of local extension of the carcinoma was performed by computed tomography and magnetic resonance imaging,magnetic resonance imaging is more effective to the left atrium.Patients with distant metastases were excluded by computed tomography and bone scintigram.Five of the nine underwent left pneumonectomy and three right pneumonectomy.A posterolateral thoracotomy is needed to provide the best exposure for these complicated resections.At operation the pericardium was opened widely and the margin of invasion confirmed by digital palpation.All patients had invasion of carcinoma of left atrium and undergone en bloc resection of the left or right lung and part of the left atrium.The entire lung was lifted up,the atrium resected partially under atrial clamping,extended resection of the left atrium is required to achieve negative margins and prevent tumor embolism.The atrial wall was excised about 1.5～3.7cm,at a distance of 0.5cm from the margin of the invading tumour and the stump of the atrium was closed in one layer with 3-0 prolene sutures.All patients received ipsilateral hilar or/and mediastinal lymph nodes dissection.Five patients had epidermoid carcinoma,three adenocarcinoma and one an adenosquamous.On the basis of postoperative macroscopic and pathological findings,the patients were classified as follows six T4N2M0 and three T4N1M0.Each of these patients received chemotherapy and radiotherapy after operation.There was no operative death and fatal postoperative complications.8 patients have survived from 8 to 61 months,postoperatively without signs of metastasis or recurrence of the carcinoma.One patient died of metastasis of brain at 11 months after operation.
Our experience suggests that an extended surgical approach to lung carcinoma is justified in selected patients,complete resection appears to offer a chance for longer survival in patients with advanced lung carcinoma that extends directly into atrium and without postoperative complications.■
作者单位：ZHANG Lin-you 张临友(Department of Thoracic Surgery,The Second Affiliated Hospital,Harbin Medical University,Harbin 150086,China)；
(ZHANG Lin-you 张临友 LI Gang 李刚 TAN Pei-lin 谭佩林)
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