摘要
目的 探讨右肺中叶疾病 (简称中叶疾病 )的诊断与外科治疗的特殊性和规律性 ,为临床诊治提供依据。 方法 回顾分析我院 1989年 1月～ 2 0 0 2年 4月手术治疗中叶疾病 16 3例的临床资料及随访结果。 结果 16 3例中 ,78例 (47 9% )为恶性肿瘤 ,85例 (5 2 1% )为良性疾病 ;<5 0岁者 91例 ,81 3% (74例 )为良性疾病 ,显著高于恶性肿瘤的发生率 (P <0 0 1) ,≥ 5 0岁者 72例 ,84 7%(6 1例 )为恶性肿瘤 ,显著高于良性疾病的发生率 (P <0 0 1) ;11例结核患者中 8例 (72 7% )合并支气管扩张。术后除 1例因呼吸衰竭死亡外均康复出院 ;7例 (4 3% )叶间积液 ,穿刺抽液后恢复。恶性肿瘤患者的 1、3、5年生存率 ,Ⅰ、Ⅱ期分别为 88 4 % (38/ 4 3)、6 2 8% (2 7/ 4 3)、5 1 2 % (2 2 / 4 3) ,Ⅲ、Ⅳ期分别为 76 5 % (2 6 / 34)、4 1 2 % (14 / 34)、14 7% (5 / 34)。 4例楔形切除恶性肿瘤者均术后 1年内复发 ,1例接受再次手术切除中叶及下叶者术后 38个月死于全身衰竭 ,良性病变无复发。结论 (1)对中叶疾病应重视肺癌的可能 ,尤其对 5 0岁以上者 ;(2 )中叶疾病性质难以明确时 ,宜剖胸探查 ;(3)中叶结核多合并支气管扩张 ,保守治疗效果不佳 ;(4)单纯中叶切除术后在右侧第 4肋间锁骨中线内侧 2cm处放置?
Objective To discuss the principle of diagnosis and surgical treatment of middle lobe diseases of right lung. Methods We analysed the clinical data and prognosis of 163 patients who suffered from middle lobe diseases of right lung and received surgical treatment. Results There were 97 men and 66 women in the group with the ratio 1.5∶1,whose age arrangd from 13 to 74 years. The shortest course was one week, and the longest 25 years. The average course was 30.3 months.78 of 163 patients with tumors were malignant(47.9%) and 85 benign(52.1%). The number of the patients below 50 years old was 91 and 81.3% of them were benign, which was very markedly higher than that of the patients with malignant tumors ( P <0.01). The number of the patients above 50 years old was 72 and 84.7% were malignant, which was very markedly higher than that of the patients with benign tumors ( P <0.01); 8 of 11 patients (72.7%,8/11) who suffered from tuberculosis combined with bronchoactesis. One of this group died from respiratory faliure after operation, packed accumulation of fluid between lobes happened in seven cases(4.3%). The survival rate of 1、3、5 years of malignant patients at stages Ⅰ、Ⅱ were 88.4%、62.8%、51.2%,for that at stages Ⅲ、Ⅳ were 76.5%、41.2%、14.7%. All of the four patients who received vage-resection, their malignant tumors recurred in one year after operation.No benign lesion recurred in 10 years. Conclusion (1)It should be noticed that nearly half of middle lobe disease were malignant, especially to those whose ages were above 50 years old.(2) When the diagnosis is hard to be cofirmed, open-thoracic exploration should be performed in order not to delay the treatment or enlarge the range of lung resection.(3) Most of middle lobe tuberculosis may be combined with bronchoactesis.(4) Setting drianige tube may be useful to decrease the risk of interlobe accumulation of fluid. (5) Vage resection is not suitable for carcinoma of middle lobe of lung.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2003年第9期654-656,共3页
Chinese Journal of Surgery
关键词
肺疾病
诊断
治疗
外科手术
Lung diseases
Pulmonary surgical procedures
Diagnosis
