肺癌肺叶切除术后肺功能评估——上叶切除可能与肺减容手术效果相同。
Assessment of pulmonary function after lobectomy for lung cancer--upper lobectomy might have the same effect as lung volume reduction surgery.
作者信息
Kushibe Keiji, Takahama Makoto, Tojo Takashi, Kawaguchi Takeshi, Kimura Michitaka, Taniguchi Shigeki
机构信息
Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Kashihara, Nara 634-8522, Japan.
出版信息
Eur J Cardiothorac Surg. 2006 Jun;29(6):886-90. doi: 10.1016/j.ejcts.2006.02.047. Epub 2006 May 3.
OBJECTIVE
Lung volume reduction surgery (LVRS) in well-selected patients with severe emphysema results in postoperative improvement in symptoms and pulmonary function. Experience with LVRS suggests that predicted postoperative FEV(1.0) may be underestimated after lobectomy in patients with lung cancer and emphysema. As most of the patients with lung cancer have more or less emphysematous changes in the lungs, we assumed that lobectomy would achieve the same effect as LVRS even in patients without chronic obstructive pulmonary disease on the pulmonary function test. We assessed changes in pulmonary function in terms of 'volume reduction effect' after lobectomy for lung cancer.
METHODS
Forty-three patients underwent right upper lobectomy (RUL), 38 patients left upper lobectomy (LUL), 39 patients right lower lobectomy (RLL), and 38 patients left lower lobectomy (LLL). Pulmonary function tests were performed preoperatively and 6 months to 1 year after surgery.
RESULTS
Percent change in FEV(1.0) after lobectomy was -6.9+/-16.1% in RUL group, -11.2+/-16.9% in LUL group, -14.7+/-9.8% in RLL group, and -12.8+/-9.5% in LLL group. We evaluated the correlation between a preoperative FEV(1.0)% of predicted and percentage change in FEV(1.0) after lobectomy. There were no significant relationships between these variables in RLL or LLL group. In contrast, there were significant negative relationships between these variables in RUL and LUL groups. Correlation coefficients were r = -0.667, p < 0.0001 for RUL and r = -0.712, p < 0.0001 for LUL. In RUL and LUL groups, patients with a higher preoperative FEV(1.0)% of predicted had a more adverse percentage change in FEV(1.0) after surgery. In addition, all 13 patients with a preoperative FEV(1.0)% of predicted <60% in RUL and LUL groups had an increase in FEV(1.0) postoperatively. Patients with a lower preoperative FEV(1.0)% of predicted had a greater 'volume reduction effect' with an increase in FEV(1.0) after upper lobectomy.
CONCLUSION
Upper lobectomy might have a volume reduction effect.
目的
在精心挑选的重度肺气肿患者中，肺减容手术（LVRS）可使术后症状和肺功能得到改善。LVRS的经验表明，肺癌合并肺气肿患者肺叶切除术后预计的术后第1秒用力呼气容积（FEV₁.₀）可能被低估。由于大多数肺癌患者肺部或多或少存在肺气肿样改变，我们推测即使在肺功能测试中无慢性阻塞性肺疾病的患者，肺叶切除术也能达到与LVRS相同的效果。我们评估了肺癌肺叶切除术后肺功能在“容积减少效应”方面的变化。
方法
43例患者接受了右上叶切除术（RUL），38例患者接受了左上叶切除术（LUL），39例患者接受了右下叶切除术（RLL），38例患者接受了左下叶切除术（LLL）。术前及术后6个月至1年进行肺功能测试。
结果
RUL组肺叶切除术后FEV₁.₀的百分比变化为-6.9±16.1%，LUL组为-11.2±16.9%，RLL组为-14.7±9.8%，LLL组为-12.8±9.5%。我们评估了术前预计FEV₁.₀%与肺叶切除术后FEV₁.₀百分比变化之间的相关性。RLL组或LLL组中这些变量之间无显著关系。相比之下，RUL组和LUL组中这些变量之间存在显著的负相关关系。RUL组的相关系数r = -0.667，p < 0.0001；LUL组的相关系数r = -0.712，p < 0.0001。在RUL组和LUL组中，术前预计FEV₁.₀%较高的患者术后FEV₁.₀的百分比变化更不利。此外，RUL组和LUL组中术前预计FEV₁.₀%<60%的所有13例患者术后FEV₁.₀均增加。术前预计FEV₁.₀%较低的患者上叶切除术后FEV₁.₀增加，具有更大的“容积减少效应”。
结论
上叶切除术可能具有容积减少效应。
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