Thoracic Surgery Unit, Department of Cardio-Thoracic and Vascular Surgery, University Hospital of Siena, Viale Bracci, 53100 Siena, Italy.
Eur J Cardiothorac Surg. 2011 Apr;39(4):555-9. doi: 10.1016/j.ejcts.2010.07.043. Epub 2010 Sep 15.
To assess the long-term impact of standard lobectomy on respiratory function in octogenarian patients with mild/moderate chronic obstructive pulmonary disease (COPD).
We reviewed all octogenarians (n=38), who underwent lobectomy for stage I-II non-small-cell lung cancer (NSCLC) from 2000 to 2006. Inclusion criteria were: Tiffenau index<0.7, no adjuvant therapies, smoking cessation after surgery, spirometric data available after 12±3 months from surgery in the absence of relapsing disease.
After excluding 14 patients (three died perioperatively), 24 fulfilled the inclusion criteria. The median preoperative forced expiratory volume in 1s (FEV1) was 80% (range 56.7-100%). The mean change in FEV1 after lobectomy resulted in a loss of 11% (range -32% to +7%, p=0.004). Considering two groups on the basis of median FEV1 (group 1: FEV1≤80%, group 2: FEV1>80%), mean FEV1 loss after surgery was 7.9% in group 1 and 14.9% in group 2, respectively (p=0.17). No statistical differences were found between the two groups in changes after surgery of forced vital capacity (FVC), arterial oxygen and carbon-dioxide tension. Diffusion capacity of the lung for carbon monoxide (DLCO)% loss was significantly higher in group 2 compared with group 1 (-22.5% vs +1.5%, p=0.001). Six patients showed an improvement of postoperative FEV1: all had a preoperative FEV1 less than 60%, an upper or homogeneous pattern of emphysema, and received an upper lobectomy. In group 2, the FEV1 loss was not affected by the type of lobectomy whereas in group 1, the resection of lower lobe was associated to a major FEV1 loss (-14.5% vs +5.3%, p=0.05).
Octogenarians with lower preoperative FEV1% have a better late preservation of pulmonary function after lobectomy. Upper lobectomy seems to produce a lung-volume reduction effect, leading to an improvement in the expiratory volume in patients with higher airflow obstruction.
评估标准肺叶切除术对合并轻/中度慢性阻塞性肺疾病（COPD）的 80 岁以上患者呼吸功能的长期影响。
我们回顾了 2000 年至 2006 年间因 I 期- II 期非小细胞肺癌（NSCLC）行肺叶切除术的所有 80 岁以上患者（n=38）。纳入标准为：Tiffenau 指数＜0.7、无辅助治疗、术后戒烟、术后 12±3 个月无复发病例时可获得肺量计数据。
排除 14 例（3 例围手术期死亡）患者后，24 例符合纳入标准。术前用力呼气量 1 秒率（FEV1）的中位数为 80%（范围 56.7-100%）。肺叶切除术后 FEV1 的平均变化导致损失 11%（范围-32%至+7%，p=0.004）。根据 FEV1 中位数将患者分为两组（组 1：FEV1≤80%，组 2：FEV1＞80%），组 1 术后 FEV1 平均损失 7.9%，组 2 为 14.9%（p=0.17）。两组术后用力肺活量（FVC）、动脉血氧和二氧化碳分压的变化无统计学差异。组 2 的一氧化碳弥散量（DLCO）%损失明显高于组 1（-22.5% vs +1.5%，p=0.001）。6 例患者术后 FEV1 改善：所有患者术前 FEV1＜60%，肺气肿呈上或均匀型，接受上肺叶切除术。在组 2 中，肺叶切除术类型不影响 FEV1 损失，而在组 1 中，下肺叶切除术与 FEV1 主要损失相关（-14.5% vs +5.3%，p=0.05）。
术前 FEV1%较低的 80 岁以上患者肺叶切除术后肺功能长期保存较好。上肺叶切除术似乎具有肺容积减少的作用，导致气流阻塞较高的患者呼气量增加。
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