中重度肺功能障碍的毁损肺切除47例分析

Analysis of Destroyed Lung Resection for Moderate-to-severe Pulmonary Dysfunction:a Report of 47 Cases

目的总结合并中重度肺功能障碍患者施行肺切除术的临床经验,降低术后病死率及并发症发生率。方法对47例中重度肺功能障碍的毁损肺患者施行肺切除术,其中最大自主通气量占预计值百分比(MVV%)50%～68%、第1秒最大呼气量占预计值百分比(FEV1%)40%～59%36例,MVV%33%～49%、FEV1%27%～39%11例。结果 47例中施行一侧全肺切除23例,肺叶切除24例。12例(25.53%)术后1个月内发生1～4种并发症:大出血1例,低血压2例,急性左心力衰竭1例,心律失常7例(室上心动过速5例,频发房性期前收缩及室性期前收缩各1例),急性肺水肿3例,肺部感染3例,肺不张2例,支气管肺胸膜瘘3例,呼吸衰竭2例,暂时性视力障碍1例。术后1个月内因急性肺水肿死亡1例(2.13%)。术后3个月左全肺切除并发缩窄性心包炎1例(2.13%)。术后随访时间为0.5～4.0年,46例生活均能自理,可徒步登梯2楼以上高度。结论中重度肺功能障碍的毁损肺手术切除并发症高、风险大,严格的围术期处理是提高中重度肺功能障碍者施行肺切除术成功率的关键。

Objective To summarize the experience of destroyed lung resection for moderate-to-severe pulmonary dysfunction and reduce the incidence of postoperative fatality rate and complications rate.MethodsLung resection were performed in 47 patients with moderate or severe pulmonary dysfunction,of which 36 cases were MVV% 50%-68% and FEV1% 40%-59%,11 cases were MVV% 33%-49% and FEV1% 27%-39%.ResultsOperations included：pneumonectomies in 23 cases,lobectomies in 24 cases.Postoperative complications occurred in 12 patients（25.53%）within one month.Massive hemothorax in 1 case,hypotension in 1 case,acute left ventricular failure in 1 case,arrhythmia in 7（supraventricular trachycardia in 5 cases,frequent atrial premature beats in 1 case and frequent premature ventricular beats in 1 case）,acute pulmonary edema in 3 cases,pulmonary infections in 3 cases,atelectasis in 2 cases and bronchial fistula in 3 cases,respiratory failure in 2 cases and transient blindness in 1 case.1 case（2.13%）died due to acute pulmonary edema.1 case（2.13%）occurred constrictive pericarditis postopration 3 months.At follow-up 0.5-4.0 years,46 patients could take care of oneself in daily life and climb more than 1 stair.ConclusionThe complications rate and risks are high in the destroyed lung resection for moderate-to-severe pulmonary dysfunction,and strict perioperative managements were the key points for the operation.