中国肺癌杂志2018，Vol.21Issue(1)：24-31,8.DOI:10.3779/j.issn.1009-3419.2018.01.04
非小细胞肺癌合并左房瘤栓病例的手术治疗与围术期管理
Surgical Procedures and Perioperative Management for Non-small Cell Lung Cancer Complicated with Left Atrial Tumor Thrombus
摘要
Abstract
Background and objective Non-small cell lung cancer with left atrial tumor thrombus accounts for a small proportion of local advanced lung cancer. Whether surgery could bring benefits, as well as surgical options are still controversial, and have always been hot spots in surgical research. We report a single center experience of surgical treatment to non-small cell lung cancer with left atrial tumor thrombus, aim to figure out more reasonable treatment strategy. Methods From August 2006 to July 2017, a total of 11 cases of non-small cell lung cancer with left atrial tumor thrombus underwent surgery in Thoracic Surgery Department of China-Japan Friendship Hospital. Clinical data, treatment options, pathological types and prognosis of these patients were collected to perform a retrospective study. Results Of the 11 patients (mean age of 57.9),7 were men and 4 were women. Six of them received neoadjuvant radiotherapy and/or chemotherapy. All patients underwent smooth operation, including 3 cases with cardiopulmonary bypass, 1 case of posterolateral approach under extracorporeal membrane oxygenation, 6 cases of conventional posterolateral approach and 1 case of video-assisted minithoracotomy. Nine patients were evaluated as R0 resection while 2 cases were evaluated as R1 resection. The Surgeries cost an average of 292 min (210 min-380 min), with an average of 436 mL (100 mL-1,600 mL) blood loss. One patient (9.1％) died within 90 days after surgery, and another 4 cases (36.4％) suffered postoperative complications such as arrhythmia, cerebral infarction or hypoxemia.Six cases of squamous cell carcinoma, 4 cases of adenocarcinoma and 1 case of sarcomatoid carcinoma were identified by pathology. Seven cases were staged as pT4N0M0 while 4 cases were staged as pT4N1M0. Nine patients underwent adjuvant chemotherapy, and two patients underwent radiotherapy during follow-up. The overall follow-up time was 2 to 53 months, the 3-year disease-free survival rate was 30.7％, the median disease-free survival time was 31 months, the 3-year overall survival rate was 49.1％ and the median overall survival time was 33 months. Conclusion For selected patients of non-small cell lungcancer complicated with left atrial tumor thrombus, choose a reasonable surgical approach to resect both the tumor and the thrombus, strengthen the perioperative management and apply neoadjuvant/adjuvant radiotherapy and/or chemotherapy,might obtain satisfying prognosis.关键词
肺肿瘤/瘤栓/体外循环/左房切开取栓术Key words
Lung neoplasms/Tumor thrombus/Cardiopulmonary bypass/Atriotomy引用本文复制引用
鲍彤,肖飞,刘德若,郭永庆,梁朝阳..非小细胞肺癌合并左房瘤栓病例的手术治疗与围术期管理[J].中国肺癌杂志,2018,21(1):24-31,8.基金项目
本研究受中日友好医院青年科技英才计划项目(No.2014-QNYC-B-09)资助This study was supported by grants from China-Japan Friendship Hospital Youth Science and Technology Excellence Project (to Fei XIAO)(No.2014-QNYC-B-09). （No.2014-QNYC-B-09）
