低肺功能肺癌患者的手术治疗

Surgical treatment for lung cancer patients with poor pulmonary function

目的 总结低肺功能肺癌患者的术前肺功能、手术治疗方式和术后并发症 ,探讨术前肺通气功能检查在低肺功能肺癌患者手术治疗中的价值。方法 回顾性分析和总结低肺功能肺癌患者的治疗经验 ,并采用 χ2 检验进行统计。结果 181例中 ,全肺、肺叶、部分肺叶切除和探查者分别为43例、118例、16例和 4例。切除组术后总的并发症发生率为 42 .4% (75 / 177) ,总的住院死亡率为7.9% (14/ 177)。全肺、肺叶和部分肺叶切除后心肺并发症的发生率分别为 2 5 .6 % (11/ 43)、48.3%(5 7/ 118)和 31.3% (5 / 16 )。 8例术前行放疗和 (或 )化疗患者术后并发症发生率为 6 / 8,死亡率为 3/ 8。12例第 2次开胸手术患者术后并发症发生率为 6 6 .7% (8/ 12 ) ,死亡率为 33.3% (4 / 12 )。全组 1,3,5年生存率分别为 71.1% (32 / 45 )、42 .2 % (19/ 45 )和 31.1% (14/ 45 ) ;Ⅰ、Ⅱ、Ⅲ期的 5年生存率分别为 5 5 .0 %(11/ 2 0 )、2 5 .0 % (3/ 12 )和 0。结论 术前肺通气功能检查是低肺功能肺癌患者手术治疗的重要依据 ,但应结合病史、弥散功能和术前其他检查来综合判断。有术前放化疗史和对侧开胸手术史的低肺功能患者 ,术后心肺并发症和死亡率明显增加。对于早期的低肺功能肺癌患者应争取手术治疗。

Objective To summarize surgical treatment of lung cancer patients with poor pulmonary function. Methods From 1991 to 1999, 181 lung cancer patients with poor pulmonary function underwent operation. The correlation between the results of preoperative pulmonary functional tests and the postoperative cardiopulmonary complications was analyzed by Chi-square test (χ 2). Results In 181 patients, pneumonectomy was done in 43, lobectomy in 118, partial lung resection in 16 and exploration in 4. The postoperative complication and mortality rates of the resection group were 42.3% (75/177) and 7.9% (14/177). The cardiopulmonary complication rates were 25.6%, 48.3%, 31.3% in pneumonectomy, lobectomy and partial lung resection. The morbidity and mortality rates of 8 patients who received preoperative chemotherapy and/or radiotherapy were 75.0% and 37.5%. The morbidity and mortality rates of 12 patients who had had a previous history of thoracotomy were 66.7% and 33.3%. In the present series, the 1-, 3- and 5-year survival rates were 71.1%, 42.2% and 31.1%. The 5-year survival rates of patients with stage Ⅰ, Ⅱ and Ⅲ lesions were 55.0%, 25.0% and 0. Conclusion Preoperative spirometry is an important evaluation test for lung cancer patients with poor pulmonary function. It should be evaluated in combination with other pulmonary function tests such as CO 2 diffusion and cardiopulmonary excise tests, etc whenever possible. Patients with a history of thoracotomy, chemotherapy and radiotherapy should be carefully evaluated before operation to avoid high morbidity and mortality. Stage Ⅰ and Ⅱ lung cancer patients with poor pulmonary function can undergo operation if they have been well managed preoperatively and well taken care of with nursing care perioperatively.