重度肺功能减退肺疾病肺切除术18例体会

Experiences of lung resection in 18 cases of lung diseases with poor pulmonary function

目的探讨重度肺功能减退对肺切除术的影响、手术适应症和围手术期管理。方法选择 1995年 1月～ 1999年 12月重度肺功能减退肺切除术 18例进行回顾分析。肺癌 12例 ,多发肺囊肿 3例 ,肺气肿肺大疱 3例。全肺切除术 9例 ,肺叶切除术 5例 ,肺楔形切除术2例 ,电视胸腔镜肺大疱切除术 2例。术前 MVV≤ 5 0 % 13例 ,其中 <40 % 7例 ;FEV1 .0 ≤ 1.5 L 15例 ,其中 <1.0 L 8例 ;FVC≤ 5 0 %6例 ,其中 <40 % 3例 ;RV/TL C≥ 45 % 12例 ,>5 0 % 10例。结果本组 18例无手术死亡。术后并发症 9例 ,其中呼吸衰竭 6例 ,心力衰竭 2例 ,心律紊乱 1例。结论重度肺功能减退肺切除术有较大的风险 ,要根据肺功能状态和病变范围并结合心电图。

Objective To explore the effect of severe pulmonary hypofunction on lung resection, and indications of operation and perioperation management.Methods 18 cases of lung resection for severe pulmonary hypofunction were analyzed retrospectively from January 1995 to December 1999,including 12 lung cancer cases,3 cyst-ling cases and 3 emphysema with bullae cases. Among them, 9 experienced pneumonectomy, 5 lobectomy of lung , 2 pulmonary wedging and 2 bulla ectomy under vadio-assisted-thoracic-surgery(VATS).Before operation,MVV≤50% was in 13 cases including 7 cases of MVV<40%;FEV 1.0≤1.5 L was in 15 cases including 8 cases of FEV 1.0<1.0 L;FVC≤50% was in 6 cases including 3 cases of FVC<40%,and RV/TLC≥45% was in 12 cases and RV/TLC>50% was in 10 cases.Results 18 cases were not dead in operation. Postoperative complications occurred in 9 cases, including respiration failure of 6 cases , heart failure of 2 cases , and abnormal heart rhythm of 1 case .Conclusion Pneumonectomy for pulmonary hypofunction has higher risks, so reasonable indications should be chosen according to pulmonary function and lesion range combined with ECG and blood gas analysis.Attention should be paid to perioperation management.