Poonyagariyagorn Hataya, Mazzone Peter J
Department of Pulmonary, Allergy and Critical Care Medicine, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Semin Respir Crit Care Med. 2008 Jun;29(3):271-84. doi: 10.1055/s-2008-1076747.
Lung resection provides the best chance of cure for individuals with early-stage non-small-cell lung cancer. Lung resection will lead to a decrease in lung function. The population that develops lung cancer often has concomitant lung disease and a reduced ability to tolerate further losses in lung function. The goal of the preoperative pulmonary assessment of individuals with resectable lung cancer is to identify those individuals whose short- and long-term morbidity and mortality would be unacceptably high if surgical resection were to occur. Pulmonary function measures such as the forced expiratory volume in 1 second (FEV1) and the diffusing capacity for carbon monoxide (DLCO) are useful predictors of postoperative outcome. When lung function in not normal, the prediction of postoperative lung function from preoperative results, and the assessment of exercise capacity, can help to clarify the risks. Testing algorithms and published guidelines help to direct the order of testing. Interventions that allow us to consider resection outside of the guidelines, or to maximize the potential to tolerate lung resection, help us to offer potentially curative treatment to as many as possible. Knowledge of alternative treatment options will help to guide those deemed unfit for resection.
肺切除术为早期非小细胞肺癌患者提供了最佳的治愈机会。肺切除术会导致肺功能下降。罹患肺癌的人群往往伴有肺部疾病，且耐受肺功能进一步丧失的能力降低。对可切除肺癌患者进行术前肺评估的目的是识别那些若进行手术切除其短期和长期发病率及死亡率将高得令人无法接受的患者。诸如一秒用力呼气量（FEV1）和一氧化碳弥散量（DLCO）等肺功能指标是术后转归的有用预测指标。当肺功能不正常时，根据术前结果预测术后肺功能以及评估运动能力，有助于明确风险。检测算法和已发表的指南有助于指导检测顺序。使我们能够考虑在指南范围外进行切除或最大限度提高耐受肺切除可能性的干预措施，有助于我们为尽可能多的患者提供潜在的治愈性治疗。了解替代治疗方案将有助于指导那些被认为不适合切除的患者。
