A Clinical Study Of The Bronchial Sleeve-Lobectomy (BSL) In The Treatment Of Central Lung Cancer

Objective:Research into the bronchial sleeve lobectomy's(BSL) technical characteristics and the clinical value.Methods:Analyzing retrospectively 129 central lung cases underwent bronchial sleeve lobectomy(BSL) treament, during the period from November 1991 to December 2004 in Thoracic Surgery, Jiangxi Province Tumour Hospital. Among them, there were 41 cases underwent upper-right bronchial sleeve lobectomy(BSL);5 cases underwent upper pulmonary artery and upper-right bronchial sleeve lobectomy(BSL); 3 cases underwent superior vena cava sidecut plasty and upper-right bronchial sleeve lobectomy (BSL); 1 cases underwent partial mastectomy oesophagus musclar layer and upper-right bronchial sleeve lobectomy(BSL); 6 cases underwent inferior-right bronchial sleeve lobectomy(BSL); 11 cases underwent midst -right bronchial sleeve lobectomy(BSL); 7 cases underwent carina reconstruction plasty and upper-right bronchial sleeve lobectomy(BSL); 36 cases underwent upper-left bronchial sleeve lobectomy(BSL); 1 cases underwent left atrium sidecut and upper-left bronchial sleeve lobectomy(BSL); 7 cases underwent carina reconstruction plasty and upper-left bronchial sleeve lobectomy(BSL); 15 cases underwent inferior-right bronchial sleeve lobectomy(BSL). Postoperative chemotherapy 77 cases, postoperative radiotherapy 19 cases.Results:In the operations there was no case of death,1 case of intraoperative cardiac,which get recovered after emergency rescues by intrathoracic cardiac massage an intravenous adrenaline and atropine,6 cases of atelectasis,4 cases of arrhythmia, 1 case of anastomotic fistula,2 cases of pulmonary infection. After active treament, all patients got recovery and left hospital. Their postoperative pathologic diagnoses were lung cancer, including squamous cell carcinoma 85 cases;adenocarcinoma 19 cases;small cell carcinoma 9 cases;large cell carcinoma 2 cases; mixed carcinoma 9 cases, alveolar cell carcinoma 2 cases, other cancer types 3 cases. Pathologic stage (take UICC2009 years TNM staging as standard):stageⅠ,30 cases;stageⅡ20 cases; stageⅢa,75 cases; stageⅢb,8 cases; 12 cases of bronchial the cut edge positive. Among the 103 survivals investigated postoperatively, the longest survival time is 216 months, the shortest 4 months,median survival time 38.4 months and the survial rate of 1 year,3 years and 5 years were respectively 90.2%,59.2% and 36.9%.Conclusion:(1)The treatment of bronchus sleeve(BSL) resection in central central lung cancer cases can mostly save normal lung organization, protect its function and increase the cure rate as well as improve lifte quality. And it may be desirable implement operation for the sort of weak pulmonary function patients.It also expand the operation indicatio and the range of operation treament. (2) Bronchial sleeve lobectomy(BSL) treatment provides chances of operation for patients with tumor invaded into main bronchus, carina,bronchus aperture, pulmonary artery,et.al central lung cancer and patients with weak lung function. Reduce the ablation rate of pnenmonectomy. (3)It's postoperative cardiovascular complications, operative mortality and recurernce rate less than pnenmonectomy. But,5-year survival have an advantage over pnenmonectomy.So the treatment of bronchial sleeve resection is safe for central lung cancer, and it's the best choice for clinic. (4)Early detection,early diagnosis and early treatment remain the best therapy of central lung cancer to improve the curtive effect.