Canver C C, Cooler S D, Nichols R D
Section of Cardiothoracic Surgery, William S. Middleton Memorial Veterans Hospital, University of Wisconsin School of Medicine, Madison 53792, USA.
J Cardiovasc Surg (Torino). 1998 Aug;39(4):497-501.
The unknown but presumably poor preoperative cardiopulmonary function of U.S. Armed Forces veterans with bronchogenic cancer may dissuade surgeons performing necessary major lung resection. The purpose of this study was to investigate the relationship between preoperative cardiopulmonary risk and the outcome of veterans undergoing pulmonary resection for bronchogenic carcinoma.
A retrospective chart review was performed on 79 veterans who underwent lung resection for bronchogenic cancer between March 1990 and June 1995. Preoperative cardiac function was assessed by 1) history of heart disease (myocardial infarction, previous open heart surgery, and hypertension), 2) electrocardiogram, EKG, and 3) transthoracic echocardiography, TTE (ejection fraction and left ventricular wall motion abnormalities). Pulmonary reserve was evaluated by 1) history of lung disease (active smoking, known chronic obstructive pulmonary disease, COPD), and 2) spirometry (forced expiratory volume in 1 second, FEV1, and minute ventilation volume, MVV). Resections were performed by standard pulmonary techniques and follow-up data was available in all patients.
All patients were males except one, with a mean age of 66+/-1.0 yrs (range=32 to 81 yrs). Fifty-one patients (64.60%) had a history of COPD while one-third of the veterans were smoking and using excessive alcohol just prior to surgery. Twenty-four patients (29%) had abnormal preoperative EKG and only 10 (15%) had prior myocardial infarction. Eleven patients (13.9%) had undergone previous coronary bypass surgery. Average preoperative left ventricular ejection fraction was 63+/-2% (range=41 to 80%) and left ventricular wall motion abnormalities were present in only 6 patients (8%). Mean preoperative FEV1 was 2.2+/-0.1 L (range=0.6-4.1 L) and MW was 87+/-4 L/min (range=26-198 L/min). A lobectomy was performed in 68 patients (86.1%), pneumonectomy in 10 (12.7%), and wedge resection in 1 (1.2%). The most common types of cancer were squamous cell (36 patients) and adenocarcinoma (31 patients). While pulmonary complications (atelectasis, prolonged air leak, pneumonia) occurred in 8 patients (10%), only two (3%) suffered nonpulmonary complications (ischemic bowel disease). For all veterans with bronchogenic cancer, early (30-day) mortality after major lung resection was 3.9% (3/79): 1.5% (1/68) after lobectomy, and 20% (2/10) after pneumonectomy (p=not significant). Overall survival at 5 years was 39.5%.
Preoperative cardiopulmonary risk for veterans with bronchogenic cancer is acceptable and lung resection can be performed with good outcomes in this distinct patient population.
美国武装部队退伍军人患支气管源性癌，其术前心肺功能未知但推测较差，这可能会使外科医生不愿进行必要的肺大部切除术。本研究的目的是调查术前心肺风险与接受支气管源性癌肺切除术的退伍军人的手术结果之间的关系。
对1990年3月至1995年6月期间接受支气管源性癌肺切除术的79名退伍军人进行回顾性病历审查。术前心脏功能通过以下方式评估：1）心脏病史（心肌梗死、既往心脏直视手术和高血压）；2）心电图（EKG）；3）经胸超声心动图（TTE，射血分数和左心室壁运动异常）。肺储备通过以下方式评估：1）肺部疾病史（现吸烟、已知慢性阻塞性肺疾病，COPD）；2）肺量计（第1秒用力呼气量，FEV1，和分钟通气量，MVV）。采用标准肺部技术进行手术，所有患者均有随访数据。
除1名患者外，所有患者均为男性，平均年龄为66±1.0岁（范围=32至81岁）。51名患者（64.60%）有COPD病史，三分之一的退伍军人在手术前吸烟且酗酒。24名患者（29%）术前心电图异常，只有10名（15%）有既往心肌梗死史。11名患者（13.9%）曾接受冠状动脉搭桥手术。术前平均左心室射血分数为63±2%（范围=41至80%），仅6名患者（8%）存在左心室壁运动异常。术前平均FEV1为2.2±0.1L（范围=0.6 - 4.1L），MVV为87±4L/min（范围=26 - 198L/min）。68名患者（86.1%）行肺叶切除术，10名（12.7%）行全肺切除术，1名（1.2%）行楔形切除术。最常见的癌症类型是鳞状细胞癌（36例）和腺癌（31例）。8名患者（10%）发生肺部并发症（肺不张、持续性漏气、肺炎），只有2名（3%）发生非肺部并发症（缺血性肠病）。对于所有支气管源性癌退伍军人，肺大部切除术后早期（30天）死亡率为3.9%（3/79）：肺叶切除术后为1.5%（1/68），全肺切除术后为20%（2/10）（p=无显著性差异）。5年总生存率为39.5%。
支气管源性癌退伍军人的术前心肺风险是可接受的，在这一特殊患者群体中进行肺切除术可取得良好效果。
