肺功能检测在肺癌患者手术风险评估中的应用价值

The application value of pulmonary function test on operation risk assessment in patients with lung cancer

目的:探讨肺功能对肺癌手术的影响及术前肺功能检测对手术风险的评估价值。方法:同期对照分析20例肺通气功能重度减退、32例肺通气功能中度减退与52例肺功能正常三组病例术后并发症的发生率,采用One-Way ANOVA及χ2检验作比较。结果:重度肺通气功能减退患者术后常见低氧血症(75%)、心律失常或心功能不全(60%)、肺部感染(55%)等一般并发症,呼吸衰竭、心力衰竭等严重并发症的发生率为25%;院内病死率为10%。中度肺通气功能减退患者术后常见低氧血症(43.7%)、心律失常或心功能不全(34.3%)、肺部感染(28.1%)等一般并发症,呼吸衰竭、心力衰竭等严重并发症的发生率为12.5%;院内病死率为6.3%。正常组此四类并发症发生率分别为16.12%、9.6%、7.6%及3.8%,无院内死亡。中、重度肺通气功能减退肺癌患者术后出现低氧血症等一般并发症发生率、严重并发症和院内病死率较正常组均明显增高(P<0.05),重度肺通气功能减退组一般并发症的发生率较中度肺功能减退组明显增高(P<0.05),而严重并发症和院内病死率无显著差异(P>0.05)。结论:对于早期非小细胞肺癌合并中重度肺通气功能障碍患者,通过术前手术风险评估,仍然有部分患者能够耐受标准肺叶切除术,取得较好外科治疗效果。术后并发症发生率在可接受范围内。

Objective ：To investigate the effect of pulmonary function test on the surgical treatment for patients with lung cancer and to assess the risk of operation. Methods：Review the postoperative complications of 20 patients with severe pulmonary hypofunction ,32 patients with moderate pulmonary hypofunction and 52 patients with normal pulmonary function. One -Way ANOVA and Chi -Square test were applied to exam the data. Results.. In patients with severe pulmonary hypofunction, hypoxemia （ 75 % ）, arrhythmia and cardiac disfunction （ 60% ）, pulmonary inflammation （ 55 % ） were common postoperative complications, respiratory failure and cardiac failure （ 25 % ） were severe complications, in - hospital mortality rate was 10%. And in patients with moderate pulmonary hypofunction, hypoxemia （43.7 % ）, arrhythmia and cardiac disfunction （34.3 % ）, pulmonary inflammation （28.1% ） were common postoperative complications, respiratory failure and cardiac failure （12.5%） were severe complications, inhospital monality rate was 6.3%. In the control group,the occurrence rate respectively was 16.12% ,9.6% ,7.6% and 3.8%. No case died in hospital. Common and severe postoperative complications（hypoxemia） in patients with modemte and severe pulmonary hypofunction were remarkably higher than those in control group （P 〈 0. 05 ）, and the common complications （hypoxemia）in patients with severe pulmonary hypofunction were remarkably higher than moderate pulmonary hypofunction （ P 〈 0.05 ）, but severe complications and in - hospital mortality rate were not significantly increased （ P 〉 0. 05 ）. Conclusion： For early NSCLC patients, who has moderate and severe pulmonary hypofunction, may accepte standard lobectomy through risk factors evaluation preoperatively ,with a promising survival and acceptable complications.