Pigula F A, Keenan R J, Ferson P F, Landreneau R J
Section of Thoracic Surgery, University of Pittsburgh Medical Center, PA 15213, USA.
Ann Thorac Surg. 1996 Jan;61(1):174-6. doi: 10.1016/0003-4975(95)00828-4.
Lung reduction surgery is gaining acceptance in the treatment of patients suffering from severe diffuse emphysema. At the University of Pittsburgh 210 patients have been evaluated and 128 patients have undergone lung reduction operations.
Ten patients, representing 7.8% of the operated group, have had asymptomatic cancerous or neoplastic lesions diagnosed on preoperative evaluation or pathologic analysis of resected tissue.
Six primary lung cancers (three squamous, three adenocarcinoma) and four other neoplastic lesions (squamous dysplasia, chemodectoma, and two carcinoid tumorlets) have been identified. All patients were heavy smokers, and all had markedly impaired pulmonary function. Patients whose lesions were identified on preoperative testing underwent thoracoscopic wedge excision of the tumor alone.
Our experience suggests that patients with impaired pulmonary function (chronic obstructive pulmonary disease) presenting for lung reduction operations are at a high risk of harboring an unsuspected neoplastic lesion. Complete preoperative evaluation of radiographic studies and preoperative bronchoscopic examination are mandatory.
肺减容手术在治疗重度弥漫性肺气肿患者中越来越被认可。在匹兹堡大学，已有210例患者接受评估，128例患者接受了肺减容手术。
10例患者（占手术组的7.8%）在术前评估或切除组织的病理分析中被诊断出有无症状癌性或肿瘤性病变。
已确定6例原发性肺癌（3例鳞状细胞癌、3例腺癌）和4例其他肿瘤性病变（鳞状上皮发育异常、化学感受器瘤和2例微小类癌）。所有患者均为重度吸烟者，且肺功能均明显受损。术前检查发现病变的患者仅接受了胸腔镜下肿瘤楔形切除术。
我们的经验表明，因肺功能受损（慢性阻塞性肺疾病）而接受肺减容手术的患者存在隐匿性肿瘤性病变的高风险。术前必须对影像学研究进行全面评估并进行术前支气管镜检查。
