Gaballo Annarita, Corbo Giuseppe M, Valente Salvatore, Ciappi Giuliano
Fisiopatologia Respiratoria, Istituto di Medicina Interna e Geriatria Università Cattolica del S. Cuore, Policlinico "A. Gemelli", Roma, Italy.
Rays. 2004 Oct-Dec;29(4):391-400.
Based on a review of the literature on resectable lung cancer, pulmonary risk factors before, during and after surgery are discussed. The role of preoperative evaluation in order to determine the patient ability to withstand radical resection is considered. Spirometric indexes as forced expired volume (FEV1) and diffusing lung carbon monoxide capacity (DLCO) should be measured first. If FEV1 and DLCO are > 60% of predicted, patients are at low risk for complications and can undergo pulmonary resection. However, if FEV1 and DLCO are <60% of predicted, further evaluation with a quantitative lung scan is required. If predicted postoperative values for FEV1 and DLCO are >40%, patients can undergo lung resection, otherwise exercise testing is necessary. If the latter shows maximal oxygen uptake (VO2max) of > 15ml/Kg, surgery can be performed; if VO2max is <15 ml/Kg, patients are inoperable.
基于对可切除肺癌文献的综述，讨论了手术前、手术期间和手术后的肺部危险因素。考虑了术前评估在确定患者耐受根治性切除能力方面的作用。应首先测量肺功能指标，如用力呼气量（FEV1）和肺一氧化碳弥散量（DLCO）。如果FEV1和DLCO大于预测值的60%，患者发生并发症的风险较低，可以进行肺切除术。然而，如果FEV1和DLCO小于预测值的60%，则需要进行定量肺扫描进一步评估。如果FEV1和DLCO的预测术后值大于40%，患者可以进行肺切除术，否则需要进行运动测试。如果运动测试显示最大摄氧量（VO2max）大于15ml/Kg，则可以进行手术；如果VO2max小于15ml/Kg，则患者无法手术。
