肺切除上腔静脉置换术中静脉转流方式的临床应用研究

The clinical investigation of extracorporeal vein bypass during lobectomy combined with superior vena cava graft for lung cancer

目的 探讨晚期肺癌患者行肺切除合并上腔静脉切除人造血管置换术期间 ,上腔静脉血转流到下腔静脉的有效方法。方法 5 5例肺癌伴上腔静脉侵犯的患者 ,按不同的静脉转流方法分为三组 :弃血组( 2 0例 )、放血组 ( 2 0例 )和外转流组 ( 15例 ) ,在静吸复合气管插管全身麻醉下施行肺癌根治性切除以及上腔静脉切除人造血管置换术。监测心电图、平均动脉压、上腔静脉压和血红蛋白。结果 上腔静脉阻断期间 ,外转流组患者平均上腔静脉压力明显低于放血组和弃血组 (P <0 .0 5 ) ,且波动小。弃血组平均动脉压和血红蛋白低于放血组和外转流组 (P <0 .0 5 ) ,输血量明显增多。全部患者手术经过顺利 ,术毕安返监护室 ,未发现神经系统损害的症状及体征 ,如期出院。结论 在上腔静脉切除人造血管置换时体外上下腔静脉转流方法可维持稳定的血流动力学和较低的中心静脉压 ,有利于大脑的灌注 ,并能明显减少出血量 。

Objecitve To evaluate the benefits of three methods of extracorporeal vein bypass from superior vena cava (SVC) to femoral vein during lobectomy and SVC graft in patients with lung cancer. Methods Fifty five cases selected from the patients with lung cancer who had undergone lobectomy combined with SVC graft by sortilege were divided into 3 groups: blood discarding group ( n =20), blood drainage group ( n =20) and extracorporeal bypass group ( n =15). The mean arterial pressure (MAP) and SVC pressure were continuously monitored during the SVC graft. Hemoglobin (Hb) was measured before and during the SVC clamping and after the SVC off clamping. Results During SVC clamping, the patients in extracorporeal bypass group had a significantly lower SVC pressure than blood discarding group and blood drainage group, and there were significant decreases in MAP and Hb and increase in blood loss in blood discarding group than the other two groups. All the patients underwent a smooth operation and safely returned to intensive care unit. None of them involved any neurologically injured signs and symptoms. Conclusion Extracorporeal SVC bypass can maintain a very stable hemodynamics and low SVCP during SVC resection and artificial vessel graft, which is an avail of brain perfusion and blood saving.