Huang Chuan, Ma Chao, Wu Qingjun, Jiao Peng, Sun Yaoguang, Tian Wenxin, Yu Hanbo, Huang Wen, Wang Yongzhong, Tong Hongfeng
Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China.
Zhongguo Fei Ai Za Zhi. 2020 May 20;23(5):343-350. doi: 10.3779/j.issn.1009-3419.2020.104.19.
Interstitial lung disease (ILD) is a group of diffuse lung diseases that mainly involve the interstitial and alveolar cavities and result in loss of alveolar-capillary functional units, leading to restrictive ventilatory dysfunction and diffusion impairment. There was an increased incidence of lung cancer on the basis of ILD, and perioperative risk of patients with lung cancer combined with ILD (LC-ILD) was significantly increased. The aim of this study is to summarize the safety and experience of surgical treatment of LC-ILD.
A retrospective analysis was performed on 23 patients with LC-ILD who underwent pneumonectomy in Beijing Hospital from January 2012 to December 2019, and their clinical manifestations, image feature, pathology, surgical safety, perioperative complications and treatment experience were summarized.
A total of 23 patients were included in this study, including 20 males (87.0%) with an average age of (69.1±7.8) years, and 19 cases (82.6%) were smokers. Of the ILD types, 14 cases (60.9%) were idiopathic pulmonary fibrosis, 7 cases (30.4%) were idiopathic nonspecific interstitial pneumonia, and 2 (8.7%) were interstitial lung disease associated with connective tissue diseases. The pathology of lung cancer included adenocarcinoma (30.4%, 7/23), small cell carcinoma (30.4%, 7/23), squamous cell carcinoma (26.1%, 6/23), small cell carcinoma mixed with squamous cell carcinoma (4.3%, 1/23) and large cell neuroendocrine carcinoma (8.7%, 2/23). Surgical approaches included video assisted thoracoscopy (69.6%, 16/23) and anterolateral thoracotomy (30.4%, 7/23), with lobectomy (52.2%, 12/23), double lobectomy (4.3%, 1/23), and sublobectomy (39.1%, 9/23). There were 11 cases (47.8%) of postoperative complications, including 8 cases (34.8%) of pulmonary complications, 4 cases (17.4%) of acute exacerbation of ILD (AE-ILD), 6 cases (26.1%) of atrial fibrillation, and 1 case (4.3%) of acute left ventricular dysfunction. The 90-day mortality is 8.7% (2/23) and the cause of death was acute exacerbation of ILD.
Most of LC-ILD were elderly patients with multiple comorbidities and decreased pulmonary function, leading to significantly increased surgical risk. The ILD should be fully evaluated and controlled before surgery, intraoperative trauma should be minimized, and special attention should be paid to pulmonary complications and AE-ILD after surgery. Postoperative AE-ILD has a poor prognosis and glucocorticoids may be effective. Early diagnosis and treatment is the key to treatment of AE-ILD.
间质性肺疾病（ILD）是一组主要累及肺间质和肺泡腔，导致肺泡 - 毛细血管功能单位丧失，进而引起限制性通气功能障碍和弥散功能受损的弥漫性肺疾病。ILD基础上肺癌发病率增加，肺癌合并ILD（LC - ILD）患者围手术期风险显著增加。本研究旨在总结LC - ILD手术治疗的安全性及经验。
对2012年1月至2019年12月在北京医院接受肺切除术的23例LC - ILD患者进行回顾性分析，总结其临床表现、影像特征、病理、手术安全性、围手术期并发症及治疗经验。
本研究共纳入23例患者，其中男性20例（87.0%），平均年龄（69.1±7.8）岁，19例（82.6%）为吸烟者。在ILD类型中，特发性肺纤维化14例（60.9%），特发性非特异性间质性肺炎7例（30.4%），结缔组织病相关间质性肺疾病2例（8.7%）。肺癌病理类型包括腺癌（30.4%，7/23）、小细胞癌（30.4%，7/23）、鳞癌（26.1%，6/23）、小细胞癌合并鳞癌（4.3%，1/23）和大细胞神经内分泌癌（8.7%，2/23）。手术方式包括电视辅助胸腔镜手术（69.6%，16/23）和前外侧开胸手术（30.4%，7/23），肺叶切除术（52.2%，12/23）、双肺叶切除术（4.3%，1/23）和肺段切除术（39.1%，9/23）。术后并发症11例（47.8%），其中肺部并发症8例（34.8%），ILD急性加重（AE - ILD）4例（17.4%），心房颤动6例（26.1%），急性左心室功能障碍1例（4.3%）。90天死亡率为8.7%（2/23），死亡原因是ILD急性加重。
多数LC - ILD患者为老年，合并多种基础疾病，肺功能下降，导致手术风险显著增加。术前应充分评估并控制ILD，术中尽量减少创伤，术后应特别关注肺部并发症及AE - ILD。术后AE - ILD预后较差，糖皮质激素可能有效。早期诊断和治疗是AE - ILD治疗的关键。
