万博专业版间皮瘤胸膜切除术 /脱皮

02. Overview

胸膜切除术/脱皮性如何治疗间皮瘤？万博专业版

P/D treats pleural mesothelioma by removing cancer tissue. A P/D procedure involves surgical removal of the external lining of the lung (the pleura). Doctors will also remove visible tumors from the chest cavity. There are several variations of this procedure, but they all share a common goal.

许多人的目标间皮瘤的手术治疗万博专业版, including P/D, is macroscopic complete resection (MCR). MCR entails the removal of all tumor tissue that is visible to the naked eye. Removal of tumor tissue is also called cytoreduction or cytoreductive surgery (CRS).

In general, the more cancer tissue doctors can remove, the better the chances of long-term survival for the patient.

因此，p/d通常是multimodal treatment计划去除尽可能多的癌细胞。完全去除癌细胞是具有挑战性的。多模式治疗结合了多种疗法，以去除所有癌细胞并延长生存率。一些多模式治疗计划将P/D与chemotherapy和/或radiation therapy。

03. P/D的类型

类型of Pleurectomy/Decortication (P/D)

根据美国临床肿瘤学学会（ASCO），P/D的定义各不相同。因此，ASCO定义了P/D的两种主要类型，如下所示。

• 胸膜切除术/脱皮（P/D）：手术去除胸膜的两层（顶叶和内脏胸膜）
• Extended Pleurectomy/Decortication (ePD):手术去除胸膜的两层，以及隔膜的癌区域和心脏壁（心包）

传统的P/D和EPD被考虑肺部比例用于间皮万博专业版瘤治疗。该标签源于以下事实：P/D和EPD不会去除肺部。胸膜外肺切除术（EPP）is another pleural mesothelioma surgery that does remove the affected lung.

根据ASCO的数据，P/D的操作性和长期风险比EPP较低。因此，ASCO建议P/D作为胸膜间皮瘤手术治疗的首选。万博专业版

非静脉切除术/脱皮对患者意味着什么？

外科医生最近开发了“非关注” P/D。该名称意味着该过程不需要切口，但事实并非如此。取而代之的是，“非出现”标签是指外科医生用来删除胸膜的方法。

In a regular P/D, doctors make an incision into the internal layer of the pleura (the visceral pleura). This allows them to remove the visceral pleura in parts. This also creates an opportunity for cancer cells to break away from tumors. Cutting the visceral pleura may also allow mesothelioma cells tometastasize，或传播到其他位置。

In a “non-incisional” P/D, doctors do not make an incision into the visceral pleura. Instead, they carefully peel it away from the lung. This alternate approach may minimize the spread of tumor cells during P/D. As such,“non-incisional”P / D可以通过微小的延长生存izing metastasis。

Doctors and researchers continue searching for ways to improve mesothelioma treatment. “Non-incisional” P/D is one example of their efforts.

04.手术程序

The Pleurectomy/Decortication Procedure

外科医生以步骤进行胸膜切除术/脱皮（P/D）。该过程可以分为两个主要阶段：胸膜切除术和脱皮化。

At each step during the two-part procedure, the surgical team takes precautions to protect important chest structures. The entire surgery takes around four to six hours.

The Pleurectomy Procedure

Surgical approach may vary depending on patient and tumor characteristics. Generally, pleurectomy involves the following steps:

1. 卫生保健提供者为患者准备手术并进行全身麻醉。
2. The patient transitions to the operating room and lays on their side. This provides easy access to the ribs and chest structures.
3. The surgeon makes an incision between the ribs called a thoracotomy.
4. 外科医生去除第六肋骨。这允许进入胸膜空间。
5. The surgeon detaches the parietal pleura (the outermost layer of the pleura) from adjacent structures. The parietal pleura may or may not be removed at this stage.
6. 如果肿瘤存在于膜片或心包（心脏壁）上，则需要切除这些肿瘤。在此阶段，外科医生将去除隔膜或心包的任何癌变部分。

The Decortication Procedure

该手术的胸膜切除术部分从其他结构中释放出顶叶。它也可能完全去除顶叶。在某些情况下，外科医生可以在脱皮手术过程中去除顶叶。剥离通常还涉及以下步骤：

1. 外科医生去除内脏胸膜（最接近肺的胸膜的层）。
2. 外科医生还去除了入侵肺组织的任何肿瘤组织。在某些情况下，肿瘤组织可能无法从肺结构中移除。外科医生将尽最大努力去除尽可能多的癌症。
3. The surgeon removes any lymph nodes that appear cancerous.
4. 如果外科医生将隔膜的一部分,他们will reconstruct that portion of the muscle. This may involve implantation of surgical mesh to replace the cancerous diaphragm tissue.
5. The surgeon closes all incisions.

切口关闭后，患者可以过渡到康复。

05. Recovery

Recovery After Pleurectomy/Decortication

胸膜切除术和脱皮化的恢复涉及患者在医院度过的时间以及在家中恢复的额外时间。患者经常移至重症监护病房（ICU）进行术后立即监测。在此期间，患者可能会注意到胸管的存在。

外科医生可以在P/D期间或几天内插入胸管。胸管有助于减轻胸部的液体和空气积聚。万博专业版间皮瘤医生can remove the chest tube once any air leaks have resolved.

Doctors also run tests to help monitor the patient after surgery. These include blood tests and a baseline chest X-ray. Patients may undergo several chest X-rays during recovery. These images help doctors monitor the patient’s progress.

Patients may stay in the hospital for a couple of weeks or more after surgery. After being discharged, recovery may take weeks to months.

06. Side Effects

Pleurectomy/Decortication Side Effects and Risks

As a surgical procedure, pleurectomy/decortication (P/D) has risks. For instance, surgeons anticipate moderate blood loss during any P/D procedure. The surgical team prepares for blood loss by ensuring the availability of donor blood before starting the procedure.

外科医生还预计由于脱皮而导致的空气泄漏大。泄漏会随着少量血液凝结在它们上时会封锁自己。

One journal article examined complication rates in 12 P/D studies. These studies included more than 850 patients. The overall complication rates in P/D for pleural mesothelioma ranged from 9% to 43%. However, surgeons regularly handle these complications, which may contribute to P/D’s low mortality rates.

在上述研究中，30天的死亡率范围从0％到6.8％。30天死亡率测量手术后30天内死亡的患者人数。在12项研究中，有6项报告了0％30天的死亡率。

因此，可能会出现并发症，但外科医生会定期有效地处理它们。

07. Benefits

胸膜切除术/脱皮的好处和优势

胸膜切除术和脱甲状腺具有多种优势作为胸膜间皮瘤治疗。万博专业版间皮瘤胸膜切除术/脱皮的优势包括：万博专业版

• Better short-term survival:在一项研究中，P/D程序仅导致1.7％的短期死亡率。在同一项研究中，EPP程序导致4.5％的短期死亡率。因此，与EPP相比，P/D的短期死亡率风险可能少于一半。短期死亡率是P/D 30天内发生的任何死亡。
• “通常更安全”的状态：As a lung-sparing procedure, P/D is viewed as safer than procedures in which a lung is removed.
• Improved quality of life:患者在P/D之后仍有两个肺。这可能比去除肺部的治疗方法更好。
• Improved tolerance for additional therapy:P/D患者手术后仍有两个肺。与接受EPP的患者相比，这可能会使他们具有更多的韧性和能够承受手术后进一步治疗的能力。
• 广泛的资格范围：与EPP等其他选择相比，可以认为有资格使用P/D的患者更多。

These and other factors led experts to recommend P/D as the first choice for pleural mesothelioma surgery. However, not every patient will be eligible for P/D. Pleural mesothelioma patients should discuss surgical and其他间皮瘤治万博专业版疗选择与专家。专家可以帮助患者为自己的独特情况做出最佳决定。

08.生存

胸膜切除术/脱皮预后和生存

间皮瘤的预后和生存万博专业版pleurectomy/decortication depend on several factors.Mesothelioma stage，治疗方法和患者特征都可能影响生存。In studies of P/D and ePD for mesothelioma, median survival ranges from 10 to 57 months。

在一项研究中，90例胸皮瘤患者接受了多模式疗法。万博专业版他们的治疗始于全身化疗，其次是P/D。手术后，能够耐受它的患者接受了额外的化疗。化学疗法包括pemetrexed加顺铂或者卡铂。

Median overall survival in the study was 57 months. The 1-year and 3-year survival rates were 93% and 65%, respectively.

Studies have also investigated P/D combined with光动力疗法和/或radiation.临床试验And other medical studies are currently exploring additional P/D-based therapies.

09.资格

胸膜切除术/剥离资格

根据专家的说法P/D可以成功用于大多数胸膜间皮瘤病例万博专业版。

Historically, experts considered pleurectomy/decortication (P/D) as a姑息治疗。姑息治疗旨在减轻症状并改善生活质量。姑息治疗通常不会旨在杀死或减缓癌症的生长。

Today, P/D still provides palliation. However, experts now recommend P/D as the first choice for surgical treatment of pleural mesothelioma.

在早期诊断的患者可以通过P/D治疗获得最佳结果。专家已将以下列为P/D的潜在合格特征：

• Mesothelioma tumors are confined to one side of the body.
• P/D不会对患者构成不合理的风险。
• 患者的心肺功能较差，没有资格获得EPP。
• Patient has early-stage mesothelioma with a minimal number of tumors.
• 患者患有广泛的间皮瘤，已扩散到其他基本结构。万博专业版
• 患者的年龄更高。

一些医生可能认为某些特征是p/d的资格。这些特征包括：

• 双相或者肉瘤细胞类型
• 具有大量肺部侵袭的肿瘤

A狗万 可以为患者提供P/D资格的建议。他们可以为患者的独特病例制定个性化治疗计划。