肺门及叶间钙化淋巴结对肺癌手术影响的研究

Study on the Effect of Hilar and Interlobar Calcified Lymph Nodes on Lung Cancer Operation

目的探讨肺门及叶间钙化淋巴结对肺癌手术的影响及应对方法。方法回顾性分析该院胸外科2012年5月—2014年5月所做的148例肺癌手术,42例患者肺门及或叶间肺动脉处存在粘连紧密的钙化淋巴结。以有无此类钙化淋巴结将所有患者分为两组,即钙化淋巴结组和无钙化淋巴结组(对照组)统计每组的各项指标,分析钙化淋巴结对肺癌手术的影响,总结肺门及叶间钙化淋巴结的术中处理方法及体会。结果全部患者手术顺利,钙化淋巴结组手术平均时间较对照组手术时间延长[(196.0±55.4)min对(125.1±47.8)min]、平均术中出血明显增加[(577.8±214.4)m L对(413.9±193.5)m L],差异有统计学意义(P<0.05)。肺门及叶间钙化淋巴结组术中平均出血量明显高于对照组,差异有统计学意义(P<0.05)。26例接受胸腔镜手术的钙化淋巴结组患者中,14例中转的平均出血量高于全腔镜手术的近一倍,差异有统计学意义(P<0.05)。结论肺门及叶间钙化淋巴结增加了肺癌手术,尤其是胸腔镜手术的难度及风险,手术前应选择恰当的手术方式,术中应谨慎操作,必要时根据术中具体情况,更改手术方式,保障患者的生命安全。

Objective To study on the effect of hilar and interlobar calcified lymph nodes on lung cancer operation and the corresponding coping approach. Methods A retrospective analysis was conducted on the 148 cases underwent lung cancer operation in Department of Thoracic Surgery of our hospital from May 2012 to May 2014. Of them, 42 cases had closely accretive calcified lymph nodes in hilus of lung or lobar pulmonary artery. The patients were divided into two groups, the calcified lymph nodes group and non-calcified lymph nodes(control group) in accordance with whether the patients had closely accretive calcified lymph nodes.The indexes of the two groups were counted. The effect of calcified lymph nodes on the lung cancer operation was analyzed. And the intraoperative dealing ways and experience for hilar and interlobar calcified lymph nodes were summarized. Results The operation of all the patients was implemented successfully. The mean duration of operation was much longer in the calcified lymph nodes group than in the control group[(196.0±55.4) min vs(125.1±47.8) min], the mean intraoperative blood loss was much more in the calcified lymph nodes group than in the control group [(577.8 ±214.4) m L vs(413.9±193.5) m L], with statistically significant difference, P <0.05. The calcified lymph nodes group had much more mean intraoperative blood loss than the control group, with statistically significant difference, P <0.05. Of the 26 cases with thoracoscope-assisted thoracic surgery in calcified lymph nodes group, the average amount of bleeding of 14 cases converted to open chest operation was nearly more than doubled than those with thoracoscope-assisted thoracic surgery with statistically significant difference, P <0.05. Conclusion Hilar and interlobar calcified lymph nodes increase the difficulty of lung cancer operation, especially the difficulty and risk of thoracoscope-assisted thoracic surgery. Appropriate surgical mode should be selected before the surgery, and the surgery should be operated cautiously, changing the surgical mode in accordance with the conditions of the patients when necessary so as to ensure the life safety of the patients.