Suzuki S, Ono S, Tabata T, Noda M, Chida M, Ashino Y, Ueda S, Hoshikawa Y, Maeda S, Nishimura T, Tanita T, Fujimura S
Department of Thoracic Surgery, Tohoku University, Sendai, Japan.
Kyobu Geka. 1997 Aug;50(9):733-7; discussion 738-9.
We presented 7 cases who were performed the second lobectomy for the second lung cancer after the first successful lobectomy on the contralateral lung (3 cases for right upper lobectomy + left lower lobectomy and 4 cases for right upper lobectomy + left lower lobectomy). In 6 patients, the predicted postoperative FEV1 estimated by multiplying the preoperative FEV1 by the fraction of perfusion to the contralateral lung was less than 800 ml/m2BSA, which is our first cut-off for identifying lung resection candidates. Unilateral pulmonary arterial occlusion test (UPAO) revealed that total pulmonary vascular resistance (TPVRI) in 3 of those 6 patients was lower than 700 dyne.sec.cm-5/m2BSA, our second cut-off for lung resection. More precise postlobectomy pulmonary hemodynamics in another 3 of those 6 patients were then estimated by adapting selective pulmonary occlusion test (SPAO). Since TPVRI during SPAO was lower than the cut-off value, it was suggested that second lobectomy would be feasible with low incidence of post operative cardiopulmonary complication. There was no serious complications in all 7 cases during their postoperative course. We believe that more precise prediction of postoperative pulmonary hemodynamics by adapting UPAO and SPAO could be one of the tools to minimumize postoperative cardiopulmonary complications in those patients needed second lobectomy for the second lung cancer after the first successful lobectomy on the contralateral lung even though their impaired lung fung function.
我们报告了7例患者，他们在对侧肺首次成功肺叶切除术后因第二次肺癌接受了第二次肺叶切除术（3例为右上叶切除+左下叶切除，4例为右中叶切除+左下叶切除）。6例患者中，通过将术前第一秒用力呼气容积（FEV1）乘以对侧肺灌注分数估算的预计术后FEV1小于800 ml/m²体表面积，这是我们筛选肺切除候选者的第一个临界值。单侧肺动脉闭塞试验（UPAO）显示，这6例患者中有3例的总肺血管阻力指数（TPVRI）低于700达因·秒·厘米⁻⁵/m²体表面积，这是我们肺切除的第二个临界值。然后，通过采用选择性肺闭塞试验（SPAO）对这6例患者中的另外3例进行了更精确的肺叶切除术后肺血流动力学评估。由于SPAO期间TPVRI低于临界值，提示第二次肺叶切除术可行，术后心肺并发症发生率低。所有7例患者术后过程中均无严重并发症。我们认为，对于那些在对侧肺首次成功肺叶切除术后因第二次肺癌需要进行第二次肺叶切除术的患者，即使其肺功能受损，通过采用UPAO和SPAO更精确地预测术后肺血流动力学可能是将术后心肺并发症降至最低的工具之一。
