因体循环血流经支气管肺分流导致肺动脉高压而行单侧毁损肺肺切除术。

Tanaka Hisaichi, Matsumura Akihide, Okumura Meinoshin, Iuchi Keiji

Department of Surgery, National Hospital Organization Kinki-chuo Chest Medical Center, 1180 Nagasonechou Sakai city, Osaka 591-8555, Japan.

Eur J Cardiothorac Surg. 2005 Sep;28(3):389-93. doi: 10.1016/j.ejcts.2005.04.044.

OBJECTIVE

Three decades ago, a few patients with pulmonary hypertension and respiratory failure associated with a unilateral destroyed lung were reported to have been treated by a pneumonectomy. In the present study, we investigated the clinical features, operative indications, and results of four cases with pulmonary hypertension that underwent a pneumonectomy for a unilateral destroyed lung.

METHODS

Four patients (three males, one female) with a destroyed lung and pulmonary hypertension (mean pulmonary arterial pressure >25 mmHg) were treated by a pneumonectomy between 1999 and 2002 at our institution. Their mean age was 59 years old (range 42-68 years). The underlying lung disease, Medical Research Council (MRC) dyspnea scale, respiratory function, arterial blood gas analysis, pulmonary arterial pressure, preoperative management, operative procedure, and postoperative course for each were reviewed retrospectively.

RESULTS

The underlying lung disease that caused the destroyed lung was bronchiectasis in two patients, chronic empyema with bronchopleural fistula in one, and necrotizing pneumonia in one. The average mean pulmonary artery pressure was 33 mmHg (range 25-42 mmHg), which decreased to 27 mmHg (range 19-36 mmHg) after occlusion of the pulmonary artery in the affected lung. Following the pneumonectomy, the average mean pulmonary artery pressure was decreased to 17 mmHg (range 11-25 mmHg). Chronic inflammatory symptoms and functional impairments (showed by blood gas analysis, pulmonary arterial pressure, or MRC dyspnea scale) improved post-pneumonectomy. There was no operative death, though postoperative cardiorespiratory failure occurred in one patient. All patients were discharged from the hospital.

CONCLUSIONS

We concluded that a pneumonectomy procedure may be indicated for selected patients with a unilateral destroyed lung and pulmonary hypertension due to systemic blood flow though broncho-pulmonary shunts.

目的

三十年前，有报道称少数患有肺动脉高压和呼吸衰竭且伴有单侧毁损肺的患者接受了肺切除术治疗。在本研究中，我们调查了4例因单侧毁损肺而接受肺切除术的肺动脉高压患者的临床特征、手术指征及手术结果。

方法

1999年至2002年期间，我院对4例（3例男性，1例女性）患有毁损肺和肺动脉高压（平均肺动脉压>25 mmHg）的患者实施了肺切除术。他们的平均年龄为59岁（范围42 - 68岁）。对每例患者的基础肺部疾病、医学研究委员会（MRC）呼吸困难量表、呼吸功能、动脉血气分析、肺动脉压、术前管理、手术过程及术后病程进行回顾性分析。

结果

导致毁损肺的基础肺部疾病，2例为支气管扩张，1例为慢性脓胸伴支气管胸膜瘘，1例为坏死性肺炎。平均肺动脉压为33 mmHg（范围25 - 42 mmHg），患侧肺动脉阻断后降至27 mmHg（范围19 - 36 mmHg）。肺切除术后，平均肺动脉压降至17 mmHg（范围11 - 25 mmHg）。慢性炎症症状和功能障碍（通过血气分析、肺动脉压或MRC呼吸困难量表显示）在肺切除术后有所改善。虽有1例患者术后发生心肺功能衰竭，但无手术死亡病例。所有患者均出院。