肺功能受损患者的肺切除术。
Lung resection in patients with compromised pulmonary function.
作者信息
Cerfolio R J, Allen M S, Trastek V F, Deschamps C, Scanlon P D, Pairolero P C
机构信息
Section of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
出版信息
Ann Thorac Surg. 1996 Aug;62(2):348-51.
BACKGROUND
Some patients are denied curative pulmonary resection for lung carcinoma because of pulmonary insufficiency. To identify factors that affect postoperative morbidity and mortality, we reviewed 85 consecutive patients (53 men and 32 women) with a preoperative forced expiratory volume in 1 second of less than 1.2 L who underwent pulmonary resection for lung cancer between January 1986 and December 1990.
METHODS
Median age was 70 years (range, 49 to 82 years). Sixty patients (71%) had been previously denied operation because of pulmonary insufficiency. Preoperative pulmonary function demonstrated a median preoperative forced expiratory volume in 1 second of 1.0 L (44% of predicted normal; range, 0.5 to 1.2 L) and a diffusing capacity of the lung for carbon monoxide of 60% of predicted normal (range, 22% to 104%).
RESULTS
Pneumonectomy was done in 6 patients (7.1%), bilobectomy in 6 (7.1%), lobectomy in 38 (44.7%), segmentectomy in 12 (14.1%), and wedge excision in 29 (27.1%). The median predicted postoperative forced expiratory volume in 1 second was 0.83 L (34% of predicted normal; range, 0.45 to 1.14 L), and the median predicted postoperative diffusing capacity of the lung for carbon monoxide was 48% of predicted normal (range, 19% to 87%). Seventy-two patients (85%) received postoperative epidural analgesia. Median hospitalization was 15 days (range, 5 to 66 days). Operative mortality was 2.4%, and complications occurred in 49%. We did not identify any factors that predicted postoperative morbidity and mortality. Median follow-up was 3.2 years (range, 0.2 to 9 years). Seven patients (8%) required supplemental home oxygen. A predicted postoperative percent forced expiratory volume in 1 second less than 43% correlated with the need for home oxygen (p < 0.05). Overall 5-year survival was 44.0%. Survival for stage I cancer was 54.2%; stage II, 33.1%; and stage IIIa, 21.3%.
CONCLUSIONS
We conclude that some patients with lung cancer and compromised pulmonary function can safely undergo pulmonary resection if selected appropriately.
背景
一些患者因肺功能不全而被拒绝进行肺癌根治性肺切除术。为了确定影响术后发病率和死亡率的因素，我们回顾了1986年1月至1990年12月期间连续85例术前一秒用力呼气量小于1.2L并接受肺癌肺切除术的患者（53例男性和32例女性）。
方法
中位年龄为70岁（范围49至82岁）。60例患者（71%）此前因肺功能不全被拒绝手术。术前肺功能显示，术前一秒用力呼气量中位数为1.0L（为预测正常值的44%；范围0.5至1.2L），肺一氧化碳弥散量为预测正常值的60%（范围22%至104%）。
结果
6例患者（7.1%）行全肺切除术，6例（7.1%）行双叶切除术，38例（44.7%）行肺叶切除术，12例（14.1%）行肺段切除术，29例（27.1%）行楔形切除术。术后一秒用力呼气量预测中位数为0.83L（为预测正常值的34%；范围0.45至1.14L），术后肺一氧化碳弥散量预测中位数为预测正常值的48%（范围19%至87%）。72例患者（85%）接受了术后硬膜外镇痛。中位住院时间为15天（范围5至66天）。手术死亡率为2.4%，并发症发生率为49%。我们未发现任何预测术后发病率和死亡率的因素。中位随访时间为3.2年（范围0.2至9年）。7例患者（8%）需要家庭氧疗。术后一秒用力呼气量预测百分比小于43%与家庭氧疗需求相关（p<0.05）。总体5年生存率为44.0%。I期癌症患者生存率为54.2%；II期为33.1%；IIIa期为21.3%。
结论
我们得出结论，一些肺癌且肺功能受损的患者如果选择得当，可以安全地接受肺切除术。
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