1659例原发性肺癌围手术期的处理

The perioperative treatment for lung carcinoma of 1659 cases

目的 探讨原发性肺癌常见的围手术期并发症、死亡原因及处理。方法 回顾分析 1 989年 1月～ 2 0 0 2年 3月外科手术治疗的 1 6 5 9例原发性肺癌的治疗及预后情况。结果 术后并发症 1 6 1人次 ,其中呼吸功能不全 38例 ,肺不张 2 0例 ,肺炎 1 5例 ,心功能不全 2 7例 ,心律失常 2 9例 ,脓胸 8例 ,支气管胸膜瘘 8例 ,消化道大出血 6例 ,术后血胸 1 0例。术后总并发症发生率 <1 9 .4 %人次。手术死亡 7例 ,手术死亡率 0 4 %。手术死亡常见原因为呼吸功能不全和心功能不全。年龄越大 ,死亡率越高。其中 >6 5岁 5例 ,<6 5岁 2例。因病期晚未能行根治手术的死亡率高于行根治手术者 ,前者为 5例 ,后者为 2例 ,其中全肺切除 1例 ,肺叶切除 1例。肺癌的临床分期越晚 ,死亡率越高。在死亡的 7例中 ,ⅢB期以上 4例。死亡原因与病理类型也有一定的关系 ,在死亡的 7例中 ,腺癌、小细胞癌及大细胞癌占 5例 ,鳞癌仅占 2例。结论 (1 )本组 1 6 5 9例外科治疗的原发性肺癌病例中 ,统计结果显示术后常见并发症为呼吸系统并发症和心血管系统并发症。 (2 )常见原因死亡为呼吸功能不全和心功能不全。 (3)围手术期预防及处理 :术前应注意呼吸道的准备 ,术后有效保持呼吸道通畅 ,必要时行呼吸机辅助呼吸。对术前有冠心病、?

Objective To study the common complications,the causes of death and the treatment in primary lung cancer patients in the perioperative period.Methods To analyze retrospectively the treatment and prognosis of 1 659 cases of lung cancer treated by operation from January,1989 to March,2002.Results The complication occurred 161 times,of them,respiratory insufficiency 38 cases,pulmonary atelectasis 20 cases,pneumonia 15 cases,cardiac insufficiency 27 cases,arrhythmia cordis 29 cases,pyothorax 8 cases,bronchogenic pleura fistula 8 cases,upper gastrointestinal hemorrhage 6 cases and hemothorax 10 cases.19.4% complication occurred.Of them 7 cases died,death rate reached 0.4% after operation.The major causes of perioperative death with primary lung cancer patients were pulmonary and cardiac insufficiency.It had higher risks for those higher aged people in death of 7 cases,5 cases>65 years,2 cases <65 years.There were more persons of death in palliative operation than in radical operation,the former 5 cases and the later 2 cases.Among 7 cases,there was 1 cases of pneumonectomy and lobectomy respectively.The later with TNM staging the tumor was,the higher the death rate is for the cases with pulmonectomy,the later over stage ⅢB was 4 of all 7cases.Besides,the cause of death related to pathologic typing, of 7 cases of death,lung adenocarcinoma,small cell and large cell carcinoma were 5 case in all,the squamous cell only 2 cases.Conclusion (1)Respiratory and cardiovascular systems complication are the common in patients with primary lung cancer.(2)The major causes of perioperative death in lung cancer patients are pulmonary and cardiac insufficiency.(3)Elderly patients with pulmonary carcinoma as had a decreased organ function and body resistance,and in most cases,it occurred with many other chronic disease.These patients has poor tolerability to the chest open surgery,and had high risks for developing complication.It should be emphasized on the perioperative management.We should obey the basis rules on operation and try to keep the normal tissues as much as possible and to avoid the entire lung incision.The preventive messures should be taken to reduce operative mortality in the perioperative period.