肺转移瘤肺切除术后肺功能受损的危险因素：117 例前瞻性观察研究。

Risk factors for impaired lung function after pulmonary metastasectomy: a prospective observational study of 117 cases.

机构信息

Department of Thoracic Surgery, Ruhrlandklinik Essen, Essen, Germany.

出版信息

Eur J Cardiothorac Surg. 2012 Aug;42(2):e22-7. doi: 10.1093/ejcts/ezs293.

DOI:10.1093/ejcts/ezs293

PMID:22798338

Abstract

OBJECTIVES

The prediction of postoperative preserved pulmonary function is essential for ascertaining the functional operability of pulmonary metastasectomy candidates. Formulae to predict pulmonary function after metastasectomy have not yet been described. This study was undertaken to provide data about the functional loss after a pulmonary metastasectomy, which often includes non-anatomical resections or combinations with anatomical resections.

METHODS

Pulmonary function tests were performed preoperatively, postoperatively and 3 months after a pulmonary metastasectomy, and the factors potentially influencing the functional outcome were prospectively collected in a database. The functional loss was calculated as the difference in the values between the follow-up visit and the preoperative values, and the influencing factors were tested using the Mann-Whitney test.

RESULTS

A total of 162 patients were prospectively included in the study and 117 completed the study protocol with a follow-up evaluation after a mean of 3.4 months. Of these, 33 patients had bilateral resections, 30 interventions were repeated resections and adhesions were removed in 46. The greatest lung resection performed was a lobectomy in 13, with segmentectomy in 27 and wedge resection in 77 patients. The mean overall functional loss was: forced vital capacity -9.2%, total lung capacity -8.8%, forced expiratory volume in 1 s -10.8% and diffusion capacity for carbon monoxide (DLCO) -9.7%, whereas the diffusion coefficient (KCO) and pO(2) remained unchanged after 3 months. This functional loss was significant (P < 0.001) for all the parameters mentioned. The two factors were inversely found to influence the functional outcome: bilateral resection reduced spirometry values (P < 0.01), postoperative chemotherapy reduced DLCO (P = 0.011) and KCO (P = 0.029).

CONCLUSIONS

A pulmonary metastasectomy leads to a significant loss of pulmonary function after 3 months in an average patient collective. The most important factors for deteriorating lung function are a bilateral operation and postoperative chemotherapy.

摘要

目的

预测术后保留的肺功能对于确定肺转移瘤切除术候选者的功能可操作性至关重要。尚未描述预测肺转移瘤切除术后肺功能的公式。本研究旨在提供有关肺转移瘤切除术后功能丧失的数据，该手术通常包括非解剖性切除术或与解剖性切除术相结合。

方法

术前、术后和肺转移瘤切除术后 3 个月进行肺功能检查，并前瞻性地在数据库中收集可能影响功能结果的因素。功能损失计算为随访时与术前值的差值，并使用 Mann-Whitney 检验检验影响因素。

结果

共前瞻性纳入 162 例患者，117 例患者完成了研究方案，并在平均 3.4 个月后进行了随访评估。其中 33 例患者行双侧切除术，30 例患者行重复切除术，46 例患者切除粘连。实施的最大肺切除术为 13 例肺叶切除术，27 例肺段切除术和 77 例楔形切除术。总的功能损失为：用力肺活量减少 9.2%，肺总量减少 8.8%，1 秒用力呼气量减少 10.8%，一氧化碳弥散量减少 9.7%，而 3 个月后弥散系数（KCO）和 pO2 保持不变。所有提到的参数的功能损失都具有统计学意义（P < 0.001）。发现两个因素对功能结果产生相反影响：双侧切除术降低了肺量计值（P < 0.01），术后化疗降低了 DLCO（P = 0.011）和 KCO（P = 0.029）。