56例余肺切除术后早期和远期效果分析

An analysis about early and long-term curative effect of 56 cases of completion pneumonectomy

目的回顾性分析余肺切除的早期和长期结果。方法收集2003年1月至2013年7月56例行余肺切除患者资料。其中45例行常规余肺切除术（CCP）；11例行抢救性余肺切除术（RCP）。结果CCP的死亡比例和发病率分别是4．4％和33．3％；良性病变的发病率明显高于恶性肿瘤（80．0％对27．5％，P=0．04）。RCP死亡比例和发病率分别是27．3％和90．9％，高龄（P=0．046）和术前机械通气（P=0．03）与术后RCP死亡相关。5年总体生存率良性病变患者80％，恶性肺肿瘤患者30％。生存时间根据不同TNM分期而不同（Ⅰ期、Ⅱ期、Ⅲ期间相比，中位数60．0个月：35．0个月：10．0个月，P〈0．01），两次手术时间间隔（首次肺部切除术和余肺切除术）〉2年的生存率更高（中位数60．0个月：18．0个月，P〈0．01）。结论余肺切除术风险高，特别是RCP。高龄和术前机械通气与RCP术后死亡比例相关。良性病变患者CCP术后生存率较高但风险更高，对于恶性肺肿瘤患者，两次手术时间间隔（首次肺部切除术和余肺切除术）〉2年的生存率更高。

Objective This study was to analyze the early and long-term effect of completion pneumonectomy. Methods Retrospective analysis was made on the patients who underwent completion pneummonectomy in Shanghai Chest Hospital. Results There were totally 56 cases patients underwent completion pneumonectomy during January 2003 to July 2013. Among them, 45 patients received CCP, and other 11 patients received RCP. CCP refers to the complete removal of lung tissue remai- ning after an initial ipsilateral partial pulmonary resection. RCP refers to the complete removal, of residual lung due to the severe complications after pneumonectomy. The mortality and morbidity rate of CCP were 4.4% and 33.3% respectively. In the case of CCP, the incidence of benign lesions is significantly higher than the incidence of malignant tumor（80.0% vs 27.5% , P = 0.04）. The mortality and morbidity rate of RCP were 27.3% and 90.9% respectively. In the case of RCP, higher postopera- tive mortality often occurs in aged patients （ P = 0. 046 ） and patients with preoperatie mechanical ventilation （ P = 0.03 ）. Overall five-year survival rate for patients with benign lesions was 80% , and for malignant lung cancer patients, the number was 30%. Survival time differs according to the TNM staging（ a median of 60.0 months, 35.0 months, 10.0 months, stage I , stage II , stage III, P 〈 0.01 ）, and survival rate was higher when the time interval （ between the initial pulmonary resec- tion and the completion pneumoneetomy） 〉 2 years （ a median of 60.0 months, 18.0 months, P 〈 0.01 ）. Conclusion Com- pletion pneumonectomy is a high-risk surgery, especially RCP. Advanced age and preoperative mechanical ventilation are asso- ciated with higher postoperative mortality rate for RCP. As for CCP, higher postoperative risk exists in patients with benign le- sions, but the survival rate is also higher. In patients with malignant lung tumor, survival rate is higher when the time interval （ between the initial pulmonary resection and the completion pueumonectomy） 〉 2 year.