化疗对肺癌手术治疗的影响(附90例临床分析)

Chemotherapy for Lung Cancer Patients Surgery Clinical Analysis of the Impact of 90 Cases

目的 探讨术前化疗对肺癌患者手术的影响。方法 将90例肺癌患者分为两个组：术前化疗组49例，手术前先行化疗，再予手术；术后化疗组41例，先行手术，术后再予化疗。90例病例接受MVP方案化疗，周期数1～6不等。术中观察两组患者胸内组织结构的变化。记录患者手术时间、术中失血量及术后第1d引流量等指标，运用SPSS软件分析。结果 术前化疗可导致肺癌患者胸膜、肿瘤周围组织、淋巴结纤维化，以肺动脉外膜及其附近组织最为明显，因而手术风险和难度明显增加。组织纤维化程度与化疗周期数有一定相关性。术前化疗组手术时间略长（P〉0．05），术中失血量略多（P〉0．05）。两组术后引流量无差异。结论 化疗可增加肺癌患者手术的风险。针对纤维化，术中更细致的止血是减少术中、术后失血的主要手段。充足的化疗间隔，良好的术前准备及术后处理，是减少术后并发症的关键。

Objective To investigate the effects of chemotherapy to the patient＇ s operation for lung cancer. Methods 90 patients were divided randomized into two groups. 1. preoperative chemotherapy group, the patients accepted chemotherapy at first, then underwent operation, 49 cases;2, postoperative chemotherapy group, the patients accepted the chemotherapy after operation,41 cases, most of patients accepted the mvp chemotherapy regiment（ 1 - 6 course）, all patients underwent operation of lobectomy or pneumonectomy, during the operation, the change of thorax structure was observed, some indexes, which include operation time, blood lose during operation and postoperative drainage volume of first day, were recorded. the data were analysis with spss software. Results 1. it is indicated that preoperative chemotherapy conduce thoracic tissue fibrosis, which include pleura, the tissue around tumor and lymph nodes, the tissue fibrosis of pulmonary artery was most notability, which increase the risk and difficulty of operation, the serious grade of tissue fibrosis was related to the courses of chemotherapy. 2. the operation time of preoperative chemotherapy group was longer than that of postoperative chemotherapy group（ P 〉 0.05）.3. the blood lose of preoperative chemotherapy group was much than that of postoperative chemotherapy group （ P 〉 0. 05）. 4. there was no significance on postoperative drainage volume in two groups. Conclusion （1）chemotherapy increases the patients＇ operation risks for lung cancer; （2）fibrosis is an underlying risk factor for blood loss, it＇s necessary to pay more attention on carefully hemostasia during the operation. （3）to decrease the risks of postoperative complication, sufficient interval after chemotherapy, preoperative prepare and proper management after op- eration are the key factors.