实验性功能性肺叶切除X线表现和血气分析

The Chest X-ray Findings and Blood-gas Analysis of Functional Pulmonary Lobectomy

目的 观察功能性肺叶切除(functional pulmonary lobectomy,FPLT)后胸部X线平片和动脉氧分压、肺内分流 改变,探讨该手术方法的可行性和安全性。材料与方法 将16只杂种犬随机分为实验组(FPLT组)和对照组(肺 叶切除组),每组8只。实验组行靶肺叶灌注博来霉素(BLM)-碘化油乳剂,然后阻塞靶气管;对照组行靶肺叶切除。 观察术前、术后1 h及第7、14、21、28 d肺部X线表现和血气变化。结果 实验组靶肺逐渐萎陷,第28 d多数靶肺 形成肺不张、纤维化;术后1 h两组血氧饱和度均下降,实验组下降显著且肺内分流明显增加。术后第7 d动脉氧分 压恢复正常。结论 靶肺叶灌注BLM-碘化油乳剂后阻塞靶气管可形成肺不张、纤维化,血气变化与肺叶切除组 相似,达到FPLT目的。

Objective To study the feasibility and safety of functional pulmonary lobectomy （FPLT） by observing both the chest X-ray findings and the changes of blood-gas of the dogs after lobeetomy. Materials and Methods 16 hybrid healthy dogs were randomly divided into experimental group （FPLT group） and control group （lung lobe was reseeted）. In experimental groups the target lung lobes were filled with emulsion of bleomyein and lipiodol and then the target bronchus was occluded. In control groups the target lung lobes were resected. The chest X-ray findings and blood-gas were observed pre-procedure and 1st, 7th, 14th, 21st and 28th day after lobeetomy respectively. Results There were the ateleetasis and fibrosis histologically of target lung lobes observed on 28th day. The arterial oxygen pressure decreased in both groups （especially in experimental group） and intropulmonary shunt increased in experimental group one hour after procedure, then returned to normal level about 7 days later. Conclusion After the target lung lobe is filled with emulsion of bleomyein and lipiodol, the ateleetasis and fibrosis are caused after the occlusion of target bronchus, the arterial oxygen pressure is also decreased, which are similar to the effect of FPLT.