Hayashi K, Fukushima K, Sagara Y, Takeshita M
Department of Thoracic Surgery, Tokyo National Hospital, Japan.
Jpn J Thorac Cardiovasc Surg. 1999 Dec;47(12):583-7. doi: 10.1007/BF03218068.
Ten patients with lung cancer complicated by severe pulmonary emphysema, underwent lung reduction surgery between 1995 and 1997. Patients meeting the following criteria were defined as having severe pulmonary emphysema: (1) forced expiratory volume in 1 s (FEV1%) of < 55% and (2) characteristic, severe findings of emphysema in chest x-rays and chest computed tomography scans. 9 men and 1 woman (mean age: 70.8; range: 59-78 years), were all smokers (smoking index: 500-2450). Preoperative lung function showed an average percent vital capacity of 87.8% (range: 67-108%) and an average FEV1% of 35.9% (range: 27-54%). The histological types of lung cancer were squamous cell carcinoma (4 patients), adenocarcinoma (5 patients), and large cell carcinoma (1 patient). Four patients were in clinical stage IA, 3 in stage IB, and 1 each was in stages IIA, IIIA, and IIIB. Lobectomy was conducted in 3 cases and partial resection in the remaining 7. Five of the 10 patients underwent thoracoscopic resection. After surgery, patients died one at 2 months and the other at 17; 3 survived but 3 suffered cancer recurred; and 5 patients without recurrence. In complications, bronchial air leakage requiring postoperative treatment. Postoperative lung function showed an average percent vital capacity of 71.4% (range: 41-90%) and an average FEV1% of 41.3% (range: 28-61%). We found an important relationship between the location of the perfusion defect (target area) in pulmonary perfusion scintigram in relation to the lung cancer site and postoperative improvement of lung function. One patient with lung cancer associated with severe respiratory obstruction underwent lobectomy after confirmation of the perfusion defect by pulmonary perfusion scintigram. Postoperative FEV1% in this patient was restored to the preoperative level. In general, partial thoracoscopic resection was effective in patients with early-stage lung cancer.
1995年至1997年间，10例肺癌合并严重肺气肿患者接受了肺减容手术。符合以下标准的患者被定义为患有严重肺气肿：（1）一秒用力呼气量（FEV1%）<55%；（2）胸部X光片和胸部计算机断层扫描显示典型的严重肺气肿表现。9名男性和1名女性（平均年龄：70.8岁；范围：59 - 78岁），均为吸烟者（吸烟指数：500 - 2450）。术前肺功能显示肺活量平均百分比为87.8%（范围：67 - 108%），FEV1%平均为35.9%（范围：27 - 54%）。肺癌的组织学类型为鳞状细胞癌（4例）、腺癌（5例）和大细胞癌（1例）。4例患者处于临床IA期，3例处于IB期，IIA期、IIIA期和IIIB期各1例。3例行肺叶切除术，其余7例行部分切除术。10例患者中有5例接受了胸腔镜切除术。术后，1例患者在2个月时死亡，另1例在17个月时死亡；3例存活但3例癌症复发；5例患者未复发。并发症方面，有需要术后治疗的支气管漏气。术后肺功能显示肺活量平均百分比为71.4%（范围：41 - 90%），FEV1%平均为41.3%（范围：28 - 61%）。我们发现肺灌注闪烁显像中灌注缺损（靶区）的位置与肺癌部位之间以及与术后肺功能改善之间存在重要关系。1例肺癌合并严重呼吸阻塞的患者在通过肺灌注闪烁显像确认灌注缺损后接受了肺叶切除术。该患者术后FEV1%恢复到术前水平。一般来说，部分胸腔镜切除术对早期肺癌患者有效。
