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[肺癌再手术:心肺功能方面的适应证及手术方法]

[Reoperation for lung cancer: indications and operation methods in cardiopulmonary function].

作者信息

Yamaoka N, Uchiyama Y, Nakamura A, Muraoka M, Kondou M, Yamauchi H, Hashiyada H, Hashizume K

机构信息

Department of Thoracic Surgery, Oita Prefectural Hospital, Japan.

出版信息

Kyobu Geka. 1995 Jan;48(1):18-23.

PMID:7869628
Abstract

A second pulmonary resection after initial operation for lung cancer was performed 20 patients (10 with a second primary lung cancer, 8 with a metastatic lung cancer, 2 with lung abscess in pulmonary aspergillosis). All patients had radical lobectomy in first operation. Eight patients underwent completion pneumonectomy, one patient had another lobectomy, two patients underwent wedge resection after initial ipsilateral lobectomy. One patient underwent contralateral lobectomy seven patients had contralateral wedge resection after initial lobectomy. Any patient did not dead within 30 days after the reoperation, not hospital death and major complications. When a second pulmonary resection (especially, completion pneumonectomy) is required, its radicality and the need to preserve residual respiratory function and cardiac function (FEV1.0 more than 800 ml/body and %FVC more than 35%, total pulmonary vascular resistance at the unilateral pulmonary artery artery occlusion test less than 700 dyne.sec.cm-5/m2) must be considered in making the decision to operation. The five-year survival rate after reoperation for patients with lung cancer was 41.0% according to the Kaplan-Meier methods. Patients with a second primary lung cancer (the three-year survival rate, 83.5%) have appeared to do better than those with pulmonary metastasis from lung cancer (the five-year survival rate, 25.6%) These results suggest that reoperation for lung cancer can be done safety, patients undergoing reoperation have a reasonable prospect for long-term survival.

摘要

对20例肺癌初次手术后患者进行了二次肺切除术(其中10例为第二原发性肺癌,8例为转移性肺癌,2例为肺曲霉菌病合并肺脓肿)。所有患者初次手术均行根治性肺叶切除术。8例患者接受了全肺切除术,1例患者接受了再次肺叶切除术,2例患者在初次同侧肺叶切除术后接受了楔形切除术。1例患者接受了对侧肺叶切除术,7例患者在初次肺叶切除术后接受了对侧楔形切除术。再次手术后30天内无患者死亡,无医院死亡及严重并发症。当需要进行二次肺切除术(尤其是全肺切除术)时,在决定手术时必须考虑其根治性以及保留残余呼吸功能和心功能的必要性(第一秒用力呼气容积超过800 ml/体表面积,用力肺活量百分比超过35%,单侧肺动脉闭塞试验时总肺血管阻力小于700达因·秒·厘米⁻⁵/平方米)。根据Kaplan-Meier法,肺癌患者再次手术后的五年生存率为41.0%。第二原发性肺癌患者(三年生存率为83.5%)似乎比肺癌肺转移患者(五年生存率为25.6%)预后更好。这些结果表明,肺癌再次手术可以安全进行,接受再次手术的患者有合理的长期生存前景。

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