Roeslin N, Morand G
Hôpital civil, Service de Chirurgie Thoracique, Hôpitaux universitaires de Strasbourg.
Rev Pneumol Clin. 1992;48(5):231-6.
Resection surgery for lung cancer is beset with specific or non-specific complications which often darken the prognosis for life. The specific complications, related to surgical dissections, are mainly per- and postoperative haemorrhages of various origins and, less frequently, disturbances in respiration, nerve wound or chylothorax. Soon after pneumonectomy a bronchial fistula encouraged by different factors may appear (3.3% of the cases) and empyema, usually caused by staphylococci, may develop (3%). Non-specific complications may disturb the post-resection period, involving the lungs (atelectasia, parenchymal infections, acute respiratory failure) or the cardiovascular system (pulmonary embolism, dysarrhythmia). The overall perioperative mortality rate has decreased with time owing to advances in anaesthesia and intensive care: in the hands of certain medico-surgical teams it does not exceed 3%. It is significantly lower in lobar (mean: 4.5%) than in pulmonary (mean: 8.4%) resections. Enlarged resections and lymph node dissections are aggravating factors. Patients aged 70 or more do not tolerate these operations so well: their mean overall mortality rate is twice that observed in younger patients (8% on average and up to 20%). Resection surgery for lung cancer remains a necessarily hazardous procedure but is the only treatment that can cure the patient. Its success is directly conditioned by a good preoperative risk evaluation.
肺癌切除手术面临着特定或非特定的并发症，这些并发症常常会使患者的生命预后变得黯淡。与手术解剖相关的特定并发症主要包括各种原因导致的术中和术后出血，以及较少见的呼吸紊乱、神经损伤或乳糜胸。肺切除术后不久，可能会因不同因素出现支气管瘘（占病例的3.3%），还可能发生通常由葡萄球菌引起的脓胸（占3%）。非特定并发症可能会干扰术后恢复阶段，累及肺部（肺不张、实质感染、急性呼吸衰竭）或心血管系统（肺栓塞、心律失常）。由于麻醉和重症监护技术的进步，围手术期的总体死亡率随时间有所下降：在某些医疗手术团队手中，这一死亡率不超过3%。肺叶切除术的死亡率（平均为4.5%）明显低于全肺切除术（平均为8.4%）。扩大切除术和淋巴结清扫术是加重因素。70岁及以上的患者对这些手术的耐受性较差：他们的平均总体死亡率是年轻患者的两倍（平均为8%，最高可达20%）。肺癌切除手术仍然是一项必然具有风险的手术，但却是唯一能够治愈患者的治疗方法。其成功直接取决于良好的术前风险评估。
