肺癌合并慢性阻塞性肺疾病外科治疗的肺功能评价

Evaluation of lung function for lobectomy of lung cancer patients with chronic obstructive pulmonary disease(COPD)

目的评价慢性阻塞性肺疾病(COPD)患者合并肺癌行肺叶切除的手术风险和手术对肺功能的影响。方法回顾分析1998年1月至2005年1月我院收治的中度COPD合并周围型非小细胞肺癌32例患者的临床资料。其中,男29例,女3例;平均年龄(65.0±5.4)岁。病理分型:鳞癌2l例,腺癌11例;病理分期:Ⅰ期2例,II期5例,IIIa期24例,IIIb期l例。所有患者均接受肺叶切除术。结果术前患者肺功能第1秒用力呼吸容积(FEV1)和动脉氧分压平均值分别为(64±9)%和(85±12)mmHg,术后分别为(62±10)%和(87±11)mmHg,虽然FEV1略有下降,但均无显著性差异(P>0.05)。本组无围手术期死亡者。结论中度COPD患者仍有一定的肺功能储备,可耐受肺叶切除手术。

Objective To evaluate the risk and influence of lobectomy on pulmonary function of COPD patients comparied with the patients with peripheral lung cancer. Methods 32 cases of peripheral cancer complicated with moderate COPD who underwent lobectomy from January 1998 to January 2005 were analyzed retrospectively. 29 patients were male and the average age was （65.0±5.4） years. Squamous cell carcinoma in 21 patients and adenocarcinoma in 11 patients were diagnosed histologically. Pathologic staging was stage Ⅰ in 2 patients, stage Ⅱ in 5 patients, staging Ⅲa in 24 patients and Stage Ⅲb in 1 patient. All cases were undergone lobectomy. Results The average preoperative FEVI and arterial oxygen tension were （64±9）% and （85±12）mmHg, The postoperative arterial oxygen tension was （87±11 ）mmHg and FEVI was （62±10）%, there was no significant deference （P〈0.05） although FEVI was slightly decreased. Post-opera- tive mortality was 0. Conclusions The postoperative pulmonary function in the patients with lung cancer comparing with COPD who had performed lobectomies is well preserved than predicted. In this study, we clarified that in moderate COPD patients, pulmonary function is unthreatened after thoracic operation.