消化道肿瘤患者肺功能检测分析

Detection and analysis of pulmonary function of the patients with gastrointestinal tract cancer

目的检测消化道肿瘤患者的肺通气和弥散功能,探讨消化道肿瘤对肺功能的影响。方法选取116例无慢性呼吸系统疾病的消化道肿瘤患者(消化道肿瘤组)及71名健康者(对照组),检测其肺通气功能指标包括用力肺活量(FVC)、第1秒用力呼气量(FEV1)、FEV1占FVC的百分比(FEV1/FVC)、峰值呼气流速(PEF)、每分钟最大通气量(MVV),以及肺弥散功能指标肺一氧化碳弥散量(DLCO),并进行统计学分析。结果消化道肿瘤组中,胰腺癌(2/4)、胆管癌(3/9)、结肠癌(4/13)患者发生肺通气功能异常的构成比较高,胰腺癌(4/4)、腹膜癌(2/2)、直肠癌(16/17)患者发生肺弥散功能异常的构成比较高。肿瘤TNM分期Ⅱ、Ⅲ、Ⅳ期患者肺功能发生异常的构成比分别为37.1%(43/116)、30.2%(35/116)、28.4%(33/116),高于Ⅰ期患者的20.7%(24/116)。消化道肿瘤组的FVC、FEV1、PEF、用力呼气75%和50%时的瞬间流速、MVV、DLCO实测值占预计值的百分比均显著低于对照组(P值分别<0.05、0.01),两组间FEV1/FVC和用力呼气25%时的瞬间流速的差异均无统计学意义(P值均>0.05)。结论消化道肿瘤患者肺通气及弥散功能均受损,肺脏可能是消化道肿瘤的影响器官。消化道肿瘤患者的肿瘤分期及部位均影响肺功能的变化。

Objective To detect pulmonary ventilation and diffusion function of the patients with gastrointestinal tract cancer, and to explore the effect of cancers in the gastrointestinal tract on pulmonary function. Methods Totally 116 patients with gastrointestinal tract cancer and without chronic pulmonary disease （gastrointestinal tract cancer group） and 71 healthy people （control group） were enrolled in this study. Forced vital capacity （FVC）, forced expiratory volume in one second （FEV1）, FEV1/FVC, peak expiratory flow （PEF）, maximal ventilatory volume （MVV）, and diffusion capacity for carbon monoxide of lung （DLCO） were measured. Statistical analysis was made after detection. Results The ratios of abnormal pulmonary ventilation function were 2 to 4 in pancreatic cancer, 3 to 9 in cholangiocarcinoma, and 4 to 13 in colon carcinoma. The ratios of abnormal diffusion function were 4 to 4 in pancreatic cancer, 2 to 2 peritoneal carcinoma, and 16 to 17 in rectal cancer. The rates of abnormal pulmonary function in the cancer patients with TNM Ⅱ , Ⅲ, and Ⅳ level （37.1% [43/116], 30. 2%[35/116] and 28.4%[33/116]） were higher than TNM I patients （20.7% [24/116]）. FVC, FEV1, PEF, forced expiratory flow in 50% and 75%, MVV, and DLCO% in cancer group were significantly lower than those in control group （P〈0.05 or 0.01）. There were no significant differences in FEV1/FVC or forced expiratory flow in 25% between two groups （both P〉0.05）. Conclusion Pulmonary ventilation and diffusion function are impaired in the patients with gastrointestinal cancers. The lung may be the affected organ of gastrointestinal cancer. TNM classification and position of gastrointestinal cancer are related to pulmonary function.