Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, Yamaguchi, Japan.
Department of Anesthesiology, National Hospital Organization Yamaguchi Ube Medical Center, Yamaguchi, Japan.
Thorac Cancer. 2020 Dec;11(12):3528-3535. doi: 10.1111/1759-7714.13696. Epub 2020 Oct 13.
Pulmonary resection is occasionally performed in postpneumonectomy patients with contralateral lung lesions, such as metachronous or metastatic lung cancer. Careful intraoperative respiratory management is essential in such patients. This study evaluated the respiratory management of postpneumonectomy patients who underwent contralateral pulmonary resection with selective bronchial blockade of the lobe or segment to be resected.
We retrospectively analyzed the surgical findings and safety of surgery in six patients who underwent contralateral pulmonary resection with selective bronchial blockade after pneumonectomy for non-small cell lung cancer (NSCLC).
The percutaneous oxygen saturation did not decrease in any of the patients during bronchial blockade under high oxygen concentration. The median blockade time was 57.5 minutes. The operative field was tolerable secured under conditions of partial lung collapse, and partial pulmonary resection was performed as planned. Postoperatively, one patient developed acute respiratory distress syndrome due to acute exacerbation of interstitial pneumonia; however, no patients died within one month postoperatively. Two patients underwent pulmonary resection in order to obtain adequate tissue specimens to evaluate the biomarkers of multiple lung metastases. On histopathology, one patient tested positive for anaplastic lymphoma kinase (ALK) and was subsequently administered an ALK inhibitor, which prolonged survival.
In all patients, intraoperative respiratory condition under partial lung collapse remained stable, and all partial pulmonary resections were safely performed. However, surgical indications should be carefully reviewed preoperatively in patients with interstitial pneumonia.
SIGNIFICANT FINDINGS OF THE STUDY: Contralateral partial pulmonary resection was performed using selective bronchial blockade in postpneumonectomy patients. Percutaneous oxygen saturation did not decrease during the bronchial blockade under high oxygen concentration, and the operative field was tolerable secured under conditions of partial lung collapse.
Oxygen concentration can be set to the minimum level, sufficient to maintain oxygenation, during contralateral partial pulmonary resection with selective bronchial blockade.
对于因对侧肺部病变（如同时性或转移性肺癌）而接受肺切除术的患者，偶尔需要进行肺切除术。在这些患者中，术中进行仔细的呼吸管理至关重要。本研究评估了在因非小细胞肺癌（NSCLC）而行肺切除术后，对将接受对侧肺叶或肺段切除术的患者采用选择性支气管阻断术进行术中呼吸管理的效果。
我们回顾性分析了 6 例因 NSCLC 而行肺切除术后接受选择性支气管阻断术的患者的手术结果和安全性。
在高氧浓度下进行支气管阻断时，所有患者的经皮血氧饱和度均未下降。中位阻断时间为 57.5 分钟。在部分肺萎陷的条件下，手术野可耐受，并按计划进行部分肺切除术。术后，1 例患者因间质性肺炎急性加重而发生急性呼吸窘迫综合征，但无患者在术后 1 个月内死亡。为了获得评估多个肺转移瘤的生物标志物所需的充分组织标本，2 例患者接受了肺切除术。在组织病理学检查中，1 例患者检测到间变性淋巴瘤激酶（ALK）阳性，并随后接受了 ALK 抑制剂治疗，从而延长了生存时间。
在所有患者中，部分肺萎陷时的术中呼吸状况保持稳定，并且所有部分肺切除术均安全进行。但是，对于间质性肺炎患者，术前应仔细审查手术适应证。
本研究的重要发现：在肺切除术后的患者中，采用选择性支气管阻断术进行对侧部分肺切除术。在高氧浓度下进行支气管阻断时，经皮血氧饱和度不会下降，并且在部分肺萎陷的条件下可安全地进行手术野的固定。
在选择性支气管阻断对侧部分肺切除术时，可以将氧浓度设置为足以维持氧合的最低水平。
