Key words ： lung cancer;left atrium;pneumonectomy ▲

Thenumber of patients with lung cancer is increasing rapidly,cancers involving the lung arebest treated by complete,en bloc resection.When they extend into the left atrium,lungcancers are recognized to be inoperable.Introduction of the techniques of cardiovascularsurgery has made possible en bloc resection of the lung with part of the involved leftatrium.
From May 1990 toSeptember 1998,9 patients with lung cancer involving left atrium were surgically treatedin our hospital.There were 7 male and 2 female patients ranging in age from 33 to 65years.Pulmonary cancers extending into the left atrium require careful planning beforeresection.Preoperative investigation of local extension of the carcinoma was performed bycomputed tomography and magnetic resonance imaging,magnetic resonance imaging is moreeffective to the left atrium.Patients with distant metastases were excluded by computedtomography and bone scintigram.Five of the nine underwent left pneumonectomy and threeright pneumonectomy.A posterolateral thoracotomy is needed to provide the best exposurefor these complicated resections.At operation the pericardium was opened widely and themargin of invasion confirmed by digital palpation.All patients had invasion of carcinomaof left atrium and undergone en bloc resection of the left or right lung and part of theleft atrium.The entire lung was lifted up,the atrium resected partially under atrialclamping,extended resection of the left atrium is required to achieve negative margins andprevent tumor embolism.The atrial wall was excised about 1.5 ～ 3.7cm,at a distance of 0.5cm from the margin of theinvading tumour and the stump of the atrium was closed in one layer with 3-0 prolenesutures.All patients received ipsilateral hilar or/and mediastinal lymph nodesdissection.Five patients had epidermoid carcinoma,three adenocarcinoma and one anadenosquamous.On the basis of postoperative macroscopic and pathological findings,thepatients were classified as follows six T₄ N₂ M₀ and threeT₄ N₁ M₀ .Each of these patients received chemotherapy andradiotherapy after operation.There was no operative death and fatal postoperativecomplications.8 patients have survived from 8 to 61 months,postoperatively without signsof metastasis or recurrence of the carcinoma.One patient died of metastasis of brain at 11months after operation.
Our experiencesuggests that an extended surgical approach to lung carcinoma is justified in selectedpatients,complete resection appears to offer a chance for longer survival in patients withadvanced lung carcinoma that extends directly into atrium and without postoperativecomplications. ■

作者单位： ZHANGLin-you 张临友( Departmentof Thoracic Surgery,The Second Affiliated Hospital,Harbin Medical University,Harbin150086,China)； (ZHANG Lin-you 张临友 LI Gang 李刚 TAN Pei-lin 谭佩林)