医学精品课件：（参考翻译）10.2 Lung cancer

重庆医科大学临床学院教案讲稿PAGE制表时间：2004年8月重庆医科大学临床学院教案及讲稿课程名称外科学年级09级七年制授课专业胸心外科教师葛明建职称教授授课方式大课学时1题目章节SurgicalTreatmentofLungCancer教材名称外科学作者吴在德主编出版社人民卫生出版社版次第七版教学目的要求Acquireasecureoverview概述ofthefrequency,clinicalfeaturesandsurgicalmanagementoflungcancer.Understandingthesurgicaltreatmentindicationofprimarylungcancer.教学难点Pathologyoflungcancer.SurgicalTechniquesoflungcancer教学重点StagingoflungcancerIndicationsforsurgery外语要求MedicalEnglish教学方法手段CAI计算机辅助教学参考资料SurgeryoftheChest(6thedition)SabistonTextbookofSurgery(17thedition)教研室意见教学组长：教研室主任：年月日重庆医科大学临床学院教案讲稿PAGEPAGE6制表时间：2004年8月SurgicalTreatmentofLungCancerGeneralintroduction.Atfirst,whatislungcancer?Itresultsfromuncontrolledgrowthofmalignantcellsinoneorbothlungsandtracheo-bronchialtree气管支气管树,whicharisesfromprotectiveorciliated有纤毛的cellsinthebronchialepithelium.Thisdiseaseoftenbeginsasaresultofrepeatedcarcinogenicirritation致癌性刺激causingincreasedratesofcellreplication复制;Asaresultproliferation增殖ofabnormalcellsleadstohyperplasia病理性增生,dysplasia发育异常orcarcinomainsitu.Epidemiologyforlungcancer.Nowadayslungcanceristhemostcommoncancerintheworldwide.Inrecentyear,thereareabout2,000,000caseseveryyearintheworld.Indevelopingcountry,situationbecomesworse.Forexample,InChina,ithasbecomethefirstleadingcauseofcancerdeath.Itisreportedabout500,000deathseveryyearinourcountry.Cigarettesmokingisbyfar到目前为止thebiggestcarcinogenforthedevelopmentoflungcancer,responsiblefor85percentofalllungcancers.Otherriskfactorsincludefamilyhistory,environmentalandoccupationalexposuretocertainsubstances物质,exposuretoexcessiveradiation过量辐射,previousLungdiseasesandpoordietetc.SignsandsymptomsManyofushavebeenfamiliarwiththesignsandsymptomsoflungcancer,whichincludecough,hemoptysis咯血,andchestpainandsoon.ThesepicturesshowustheSVCsyndrome上腔静脉症候群.Wecanseeengorged充盈的superficialveinsoftheneckandupperchestwall.Initial最初的digitalsubtractionrightupperextremityvenogram数字减影右上肢静脉造影demonstrateshigh-gradestenosis狭窄inthemid-portion中部oftheSVCandextensivevenouscollaterals广泛的静脉络丛.Fingerclubbing杵状指isgenerallyasignoflungcancerorchroniclungdisease.Enlargementofthemostdistantpartofthefingerandnailareseen.DiagnostictechniquesThediagnostictechniquesoflungcancerincludefollowing.Let’sdiscussthemonebyone.Chestx-rayisthemostcommonlyperformeddiagnosticx-rayexamination.Lungcancercanbediagnosedorsuspectedonachestx-ray.Computedtomography(CT):amethodofbodyimaginginwhichathinx-raybeamrotates旋转aroundthepatient.Acomputeranalyzesthedatatoconstructacross-sectionalimage断层影像.Theseimagescanbestored,viewedonamonitor,orprintedonfilm.Inaddition,three-dimensionalmodelsoforganscanbecreatedbystacking堆叠theindividualimages,or"slices切片”.ThePETscan正电子发射层析扫描isadiagnosticexaminationthatusessmallamountsofradioactivitytotakedetailedpicturesofdifferentareasinsidethebody.Theimageswillshowhowyourbodyorgansandtissuesfunction.PETcannotbeusedaloneasadiagnostictool.Itsvalueisenhancedwhenitispartofalargerdiagnosticwork-up,anditiscapable得力的ofdiagnosingawiderangeofcancertypes.Currently,PETimagingisusedindetectingrecurringdisease复发性疾病early,andmonitoringtheresponsetotherapytreatments.Ultrasoundscansusehighfrequencysoundwavestoproduceanimageanddonotexposetheindividualtoradiation.Theprocedureispainlessandsafe.Ultrasoundusessoundwavestolookattheliverandtheotherorgansintheupperpartoftheabdomen.Abonescanisatestthatdetectsareasofincreasedordecreasedbonemetabolism.Thetestisperformedtoidentifyabnormalprocessesinvolvingthebonesuchastumor,infection,orfracture骨折.Mediastinoscopy纵隔镜检查isaprocedureinwhichalighted发光的instrument(mediastinoscope)isinsertedthroughaneckincision切口tovisuallyexaminethestructuresinthetopofthechestcavityandtaketissuesamples取组织样本.Mostcommonlythisprocedureisusedtoexaminelymphnodesinapatientwithlungcancer,fordiseasestagingpurposes目的.Thoracoscopy胸腔镜检查--aminimallyinvasivewayofaccessingthechestthroughsmallincision(s)todiagnoseandtreatlungcancer.ItisalsocalledVideoAssistedThoracicSurgery视频辅助胸科手术/电视辅助胸腔镜手术(VATS).Bronchoscopy支气管镜检查providesaviewoftheairwaysofthelungandallowsdoctorstocollectlungsecretionsortissuespecimens样本(biopsy).Cytologyexamination细胞学检查forsputum痰orpleuraleffusion胸液canbeusedforpathologicaldiagnosisofthedisease.PathologicalTypesGenerallylungcancerisdividedintotwotypes:non-smallcelllungcancerandsmallcelllungcancer.Non-smallcelllungcancerincludesadenocarcinoma腺癌,squamouscarcinoma鳞癌andlargecellcarcinoma大细胞癌.Smallcelllungcancerismostaggressivelungcancer,responsivetochemotherapyandradiationbutrecurrencerateishigheveninearlystage.TNMStagingTheTNMsystemprovidesinformationrelatedtotheextentofdisease,thissystemforstagegroupingofnon-smallcelllungcancerbyprimarytumor,regionallymphnode,anddistantmetastasis(TNM)wasdevelopedbytheInternationalSystemforStagingLungCancer.Trefertoprimarytumor,NisnodalinvolvementandMmeansdistantmetastasis.TXmeanstumorprovenbythepresenceofmalignantcells;TOmeansnoevidenceofprimarytumor;iscarcinomainsitu.ExceptTfactor,anotherdescriptorofStagingsystemisN.N0meansnoregionalmetastasisinregionalLymphnodes.N1meansmetastasisinipsilateral身体同侧的peribronchial支气管周的and/orperihilar门周的lymphnodesandintrapulmonary肺内nodes,includinginvolvementbydirectextension.N2meansmetastasisinipsilateralmediastinaland/orsubcarinal隆突下lymphnodes.N3meansmetastasisincontralateral对侧hilar肺门/mediastinal纵膈的/scalene斜角肌/supraclavicular锁骨上的lymphnode(s)ormetastasisinipsilateralscalene/supraclavicularlymphnode(s).M1ameanslungcancerwithcontralateralpulmonarynodulesormalignantpleuraleffusion/nodules.M1bmeanslungcancerwithdistantmetastasise.g.brain,bone,liveoradrenalgland肾上腺.ThestageIVcategoryincludesonlypatientswithevidenceofdistantmetastasis.TreatmentplanforlungcancerGenerallytreatmentforlungcancerisbasedonthetypeandstageoftumor,possibilityforremovingthetumor,andthepatient'sabilitytosurvivesurgery.Optionsincludesurgery,radiation,chemotherapy,oracombinationofthesetreatments.ForlungcancerstagedIa/bandIIa/b,surgeryshouldbebesttreatmentoptions.ForstageIIIa,chemotherapyshouldbeconducted指挥/引导atfirst,andthenfollowedbyradiotherapyorsurgery.ThetreatmentplanforstageIIIbiscombinationofchemotherapyandradiation.MeanwhileforstageIV,tumorhasspreadbeyondthechest,chemotherapyand/orpalliativecare姑息治疗issuitable.Surgicaltreatment’sprincipleforlungcanceriscompleteresection切除andpreservingthemaximumamountoffunctionallungtissue.Surgerycantakeseveralformse.g.Wedgeresection楔形切除术,Segmentectomy肺段切除术,Lobectomy叶切除术,SleeveLobotomy袖叶切断术and/orSleeveresection袖状切除术andPneumonectomy肺切除术.Let’sdiscussthembriefly.Removalofasmallpartofthelungisasegmental部分的orwedge楔形的resection,removalofanentirelobe叶ofthelungisalobectomy,andremovalofanentirelungisapneumonectomy.WedgeorsengmentalResection:Thisprocedureisusedwhenthecancerous癌的growthislocatedintheoutersectionsofthelung,andwhenalobectomycannotbeperformed,inordertosparelungtissueandfunction.Lobectomy,orremovalofalobe,isthepreferredprocedurewhenacanceroustumorinvolvesasinglelobeofthelung.Pneumonectomy:Thisprocedureisindicatedwhenalobectomycannotbeperformedforthetotalremovalofabronchialcancer.Apneumonectomyisthetotalremovalofonelung.Arightpneumonectomymeansthattherightlungissurgicallyremoved.Forexample:Arightlowerlobectomymeansthatthelowerlobeoftherightlungissurgicallyremoved.Thissurgeryisusedprimarilyinthetreatmentofbronchialcancer.SleeveResection:

Asleeveresectioncanbedonebysurgicallyremovingthecancerousportionoftheairway,leavingenoughhealthytissueforthesurgeontoreconnecttheedgesofthebronchi细支气管,thuspreservingsometissueandpulmonaryfunction.Thissurgeryisusedprimarilyfortumorslocatedeitherintherightorleftupperbronchus.Themultidisciplinary有关各种学问的approachtolungcancerisnecessaryduetothecomplexity复杂性ofthediseaseandthenumerous许多的treatmentoptions.

Treatmentsmayincludesurgery,chemotherapy,biotherapy,andradiationtherapy.

Thesetreatmentsareoftenusedincombination.Othertreatmentoptionsforlungcancerincluderadiotherapy,chemotherapy