摘要: |
目的 基于肺功能的损耗与病灶进展,探讨双侧多原发肺癌最佳的分期手术间隔时长。方法 回顾性分析2008至2019年复旦大学附属中山医院收治的121例在1年内接受分期肺部肿瘤切除术患者的临床资料,根据分期手术间隔时长分为短期组(≤6个月,n=72)与长期组(6~12个月,n=49)。比较2组患者2次手术术前肺功能[第1秒用力呼气容积(FEV1)]及病灶形态特征变化的差异。结果 短期组第2次术前FEV1下降程度大于长期组[(0.36±0.25)L vs(0.26±0.24)L,P=0.047]。短期组与长期组一期(11.1% vs 12.2%)与二期(8.3% vs 0)手术后并发症差异均无统计学意义。长期组磨玻璃结节(21.1% vs 0)、亚实性结节(47.6% vs 6.5%)及实性结节(67.0% vs 16.7%)在随访过程中进展比例均多于短期组(P<0.05)。2次手术期间,随着病灶中实性成份的增加,病灶进展率有升高趋势。结论 分期肺切除手术间隔6~12个月有利于保护双侧多原发肺癌患者肺功能;存在实性病灶时,建议在保证手术安全性的前提下,尽可能缩短分期手术间隔,甚至同期行双侧肺部病灶切除。 |
关键词: 双侧多原发肺癌 肺功能 分期手术 间隔时长 安全性 |
DOI:10.12025/j.issn.1008-6358.2022.20212783 |
分类号:R734.2 |
基金项目:国家自然科学基金(81872291,82003280),复旦大学附属中山医院青年科学基金(2020ZSQN15). |
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The analysis on the safe interval length between two-stage resections for bilateral multiple primary lung cancer |
XU Feng-kai, WANG Lin, LU Chun-lai, GU Jie, ZHU Qiao-liang, YANG Hui-qin, CHENG Tao, LIN Zong-wu, GE Di
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Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Abstract: |
Objective To explore the optimal interval length between two-stage surgery, based on the reduction of pulmonary function after the first operation and the safety of follow-up of the lesion. Methods A total of 121 patients with simultaneous bilateral multiple primary lung cancers were retrospectively enrolled, who underwent two-stage resection in one year from 2008 to 2019 in Zhongshan Hospital, Fudan University. According to the interval length between the two-stage surgery, patients were distributed into short-term (≤ 6 months) and long-term (6-12 months) groups. Changes in preoperative pulmonary function (forced expiratory volume in the first second) and lesion features (size and solid component) between two-stage operation were compared between 2 groups. Results The reduction degree of FEV1 in the short-term group was higher than that in the long-term group ([0.36±0.25] L vs[0.26±0.24] L, P=0.047). There was no significant difference in postoperative complications after the first-stage operation (11.1% vs 12.2%) and the two-stage operation (8.3% vs 0) between the two groups. The progress rate of lesion in the long-term group was higher than that in the short-term group. The progression rates of ground glass nodules (21.1% vs 0), sub-solid nodules (47.6% vs 6.5%) and solid nodules (67.0% vs 16.7%) in the long-term group were higher than those in the short-term group (P<0.05). During the follow-up time, the incidence of progression occurred had elevating trand, with solid components in the lesion increased. Conclusion The interval length of 6-12 months between two-stage operation is relatively safe for the pulmonary function, and when lesion is solid, the interval should be as short as possible, even underwent one-stage resection under ensuring surgical safety. |
Key words: bilateral multiple primary lung cancer pulmonary function two-stage operation interval length safty |