体外循环辅助下难治性胸部肿瘤的外科治疗
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摘要
背景与目的回顾性总结体外循环辅助下累及心脏或大血管的难治性胸部肿瘤外科治疗体会。方法总结我院2008年1月-2017年5月实施的体外循环下外科手术切除累及心脏或大血管的11例胸部肿瘤患者,分析所有患者的一般情况、临床特征、治疗方法、术后住院时间、并发症及随访结果。结果 11例患者均在体外循环辅助下手术。肿瘤全部切除者8例,大部分切除者3例,其中1例先行左房内转移性肺平滑肌肉瘤切除,再行右肺中下叶切除术;1例经胸骨正中切口行左肺中央型肺癌切除术;2例同时行肺动脉修补术,3例同时行部分心包切除术,3例同时行肺楔形切除术。所有患者术后症状均得到有效缓解。无院内及术后30天死亡率。3例术后出现肺部感染,于抗生素治疗后恢复。1例淋巴瘤术后6个月复发,1年后死亡;1例心包内纤维肉瘤患者于术后13个月局部复发伴广泛转移,15个月死亡,1例肺平滑肌肉瘤患者于术后15个月发现局部复发灶,予以化疗后缓解。其余8例患者均存活,且计算机断层扫描(computed tomography,CT)检查均未发现明显复发及远处转移。结论对于累及心脏或大血管的难治性胸部肿瘤可以实施体外循环辅助下的外科手术治疗,可以提高难治性胸部肿瘤的手术切除率,有效缓解对呼吸、循环功能的影响,明显延长此类患者的生存期。
Background and objective A retrospective review of the surgical treatment of refractory chest tumors involving the heart or large vessels with cardiopulmonary bypass(CPB). Methods To summarize 11 cases of chest tumor patients who had undergone cardiopulmonary bypass surgery from January 2008 to May 2017 in our hospital, and analyze the general condition, clinical characteristics, treatment methods, postoperative hospitalization time, complications and follow-up results of all patients. Results All 11 patients were operated with cardiopulmonary bypass. Total resection of tumors in 8 cases and most of the excision in 3 cases. 1 case of left atrial metastatic leiomyosarcoma were excised in the left atrium, and then the right lung resection was performed. 1 case of left lung central lung cancer resection through the median sternum incision. 2 cases underwent pulmonary artery repair at the same time, 3 cases underwent partial pericardiectomy and 3 cases underwent pulmonary wedge resection at the same time. All the patients were effectively relieved after the operation. No death rate in hospital and 30 days after operation. 3 cases of postoperative pulmonary infection were recovered after the treatment of antibiotics. 1 case of lymphoma relapsed 6 months after surgery and died one year later. 1 case of pericardial fibrosarcoma had local recurrence and extensive metastasis at 13 months after operation, and died after 15 months. 1 case of pulmonary leiomyosarcoma were found to have local recurrence 15 months after the operation and were relieved after chemotherapy. The remaining 8 patients survived, and no obvious recurrence and distant metastasis were found in the computed tomography(CT) examination. Conclusion The CPB assisted surgical treatment can be performed for patient of refractory chest tumors involving the heart or large vessels. It can improve the surgical resection rate of refractory chest tumors, effectively alleviate the effects on respiratory and circulatory functions, and significantly prolong the survival period of these patients.
Background and objective A retrospective review of the surgical treatment of refractory chest tumors involving the heart or large vessels with cardiopulmonary bypass(CPB). Methods To summarize 11 cases of chest tumor patients who had undergone cardiopulmonary bypass surgery from January 2008 to May 2017 in our hospital, and analyze the general condition, clinical characteristics, treatment methods, postoperative hospitalization time, complications and follow-up results of all patients. Results All 11 patients were operated with cardiopulmonary bypass. Total resection of tumors in 8 cases and most of the excision in 3 cases. 1 case of left atrial metastatic leiomyosarcoma were excised in the left atrium, and then the right lung resection was performed. 1 case of left lung central lung cancer resection through the median sternum incision. 2 cases underwent pulmonary artery repair at the same time, 3 cases underwent partial pericardiectomy and 3 cases underwent pulmonary wedge resection at the same time. All the patients were effectively relieved after the operation. No death rate in hospital and 30 days after operation. 3 cases of postoperative pulmonary infection were recovered after the treatment of antibiotics. 1 case of lymphoma relapsed 6 months after surgery and died one year later. 1 case of pericardial fibrosarcoma had local recurrence and extensive metastasis at 13 months after operation, and died after 15 months. 1 case of pulmonary leiomyosarcoma were found to have local recurrence 15 months after the operation and were relieved after chemotherapy. The remaining 8 patients survived, and no obvious recurrence and distant metastasis were found in the computed tomography(CT) examination. Conclusion The CPB assisted surgical treatment can be performed for patient of refractory chest tumors involving the heart or large vessels. It can improve the surgical resection rate of refractory chest tumors, effectively alleviate the effects on respiratory and circulatory functions, and significantly prolong the survival period of these patients.
引文
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7 Duan SZ,Chen YB,Yang WT.A case of primary pulmonary leiomyosarcoma with left atrium metastasis.Zhonghua Xiong Xin Xue Guan Wai Ke Za Zhi,2013,29(11):697.[段善州,陈勇兵,杨文涛.肺原发性平滑肌肉瘤伴左心房转移一例.中华胸心血管外科杂志,2013,29(11):697.]doi:10.3760/cma.j.issn.1001-4497.2013.11.019
8 Muralidaran A,Detterbeck FC,Boffa DJ,etal.Long-term survival after lung resection for non-small cell lung cancer with circulatory bypass:A systematic review.J Thorac Cardiovasc Surg,2011,142(5):1137-1142.doi:10.1016/j.jtcvs.2011.07.042
9 Ried M,Neu R,Schalke B,etal.Radical surgical resection of advanced thymoma and thymic carcinoma infiltrating the heart or great vessels with cardiopulmonary bypass support.J Cardiothorac Surg,2015,10(1):137-144.doi:10.1186/s13019-015-0346-2
10 Liu C,Xue YX,Wang DJ.Cardiopulmonary bypass related coagulation injury.Zhonghua Xiong Xin Xue Guan Wai Ke Za Zhi,2014,30(3):181-183.[刘畅,薛云星,王东进.体外循环相关凝血损伤.中华胸心血管外科杂志,2014,30(3):181-183.]doi:10.3760/cma.j.issn.1001-4497.2014.03.016
11 Maragoudakis ME,Tsopanoglou NE,Andriopoulou P,etal.Efects of thremhin/thremhosis in angiogenesis and tumour progression.Matrix Biol,2000,19(4):345-351.doi:10.1016/S0945-053X(00)00079-2
12 Vaporciyan AA,Putnam JB Jr,Smythe WR.The potential role of aprotinin in the perioperative management of malignant tumors.J Am Coll Surg,2004,198(2):266-278.doi:10.1016/j.jamcollsurg 2003.09.022
2 Turbendian H,Seastedt KP,Shavladze N,etal.Extended resection of sarcomas involving the mediastinum:a 15-year experience.Eur JCardiothorac Surg,2016,49(3):829-834.doi:10.1093/ejcts/ezv222
3 Ruffini E,Van Raemdonck D,Detterbeck F,etal.Management of thymic tumors:a survey of current practice among members of the European Society of Thoracic Surgeons.J Thorac Oncol,2011,6(3):614-623.doi:10.1097/JTO.0b013e318207cd74
4 Ruffini E,Detterbeck F,Van Raemdonck D,etal.Thymic carcinoma:a cohor t study of patients from the European societ y of thoracic surgeons database.J Thorac Oncol,2014,9(4):541-548.doi:10.1097/JTO.0000000000000128
5 Park BJ,Bacchetta M,Bains MS,etal.Surgical management of thoracic malignancies invading the heart or great vessels.Ann Thorac Surg,2004,78(3):1024-1030.doi:10.1016/j.athoracsur.2004.02.043
6 Li WW,van Boven WJ,Annema JT,etal.Management of large mediastinal masses:surgical and anesthesiological considerations.J Thorac Dis,2016,8(3):E175.doi:10.21037/jtd.2016.02.55
7 Duan SZ,Chen YB,Yang WT.A case of primary pulmonary leiomyosarcoma with left atrium metastasis.Zhonghua Xiong Xin Xue Guan Wai Ke Za Zhi,2013,29(11):697.[段善州,陈勇兵,杨文涛.肺原发性平滑肌肉瘤伴左心房转移一例.中华胸心血管外科杂志,2013,29(11):697.]doi:10.3760/cma.j.issn.1001-4497.2013.11.019
8 Muralidaran A,Detterbeck FC,Boffa DJ,etal.Long-term survival after lung resection for non-small cell lung cancer with circulatory bypass:A systematic review.J Thorac Cardiovasc Surg,2011,142(5):1137-1142.doi:10.1016/j.jtcvs.2011.07.042
9 Ried M,Neu R,Schalke B,etal.Radical surgical resection of advanced thymoma and thymic carcinoma infiltrating the heart or great vessels with cardiopulmonary bypass support.J Cardiothorac Surg,2015,10(1):137-144.doi:10.1186/s13019-015-0346-2
10 Liu C,Xue YX,Wang DJ.Cardiopulmonary bypass related coagulation injury.Zhonghua Xiong Xin Xue Guan Wai Ke Za Zhi,2014,30(3):181-183.[刘畅,薛云星,王东进.体外循环相关凝血损伤.中华胸心血管外科杂志,2014,30(3):181-183.]doi:10.3760/cma.j.issn.1001-4497.2014.03.016
11 Maragoudakis ME,Tsopanoglou NE,Andriopoulou P,etal.Efects of thremhin/thremhosis in angiogenesis and tumour progression.Matrix Biol,2000,19(4):345-351.doi:10.1016/S0945-053X(00)00079-2
12 Vaporciyan AA,Putnam JB Jr,Smythe WR.The potential role of aprotinin in the perioperative management of malignant tumors.J Am Coll Surg,2004,198(2):266-278.doi:10.1016/j.jamcollsurg 2003.09.022