Vaaler A K, Hosannah H O, Wagner R B
National Naval Medical Center, Bethesda, Maryland.
Ann Thorac Surg. 1995 Jan;59(1):178-82; discussion 183. doi: 10.1016/0003-4975(94)00823-P.
Conservative resection of a second primary lung cancer is desirable but not always feasible. We recently carried out three left pneumonectomies for the removal of metachronous primary lung cancers in patients who had previously undergone right upper lobe resection for the treatment of bronchogenic carcinoma. In each patient, the results of pulmonary function tests plus the findings from quantitative perfusion lung scans predicted a postpneumonectomy forced expiratory volume in 1 second of at least 1.00 L. All 3 patients had uncomplicated postoperative courses, and were doing satisfactorily at follow-up 2 to 6 months later. One patient died 5 months after pneumonectomy due to unrelated causes, another died 8 months after pneumonectomy from infection after resection of a brain metastasis, and the third is doing well 15 months after pneumonectomy. The rarity of previously reported cases suggests that performing a pneumonectomy after contralateral lobectomy may be considered too radical. Our experience indicates the procedure may be considered if the patient's pulmonary function meets the standard criteria for pneumonectomy.
保守性切除第二原发性肺癌是可取的，但并非总是可行。我们最近对3例患者实施了左全肺切除术，以切除异时性原发性肺癌，这些患者此前因支气管源性癌接受了右上叶切除术。在每例患者中，肺功能测试结果加上定量灌注肺扫描结果预测，肺切除术后第1秒用力呼气量至少为1.00L。所有3例患者术后过程均无并发症，在术后2至6个月的随访中情况良好。1例患者在肺切除术后5个月因无关原因死亡，另1例在肺切除术后8个月因脑转移瘤切除术后感染死亡，第3例在肺切除术后15个月情况良好。先前报道的病例罕见，提示在对侧肺叶切除术后进行全肺切除术可能被认为过于激进。我们的经验表明，如果患者的肺功能符合全肺切除术的标准标准，则可以考虑该手术。
