肺癌合并中重度COPD的外科治疗  

Surgery treatment in lung cancer combined with moderate-severe COPD

作　　者：杨鲁民[1] 沈毅[2] 陈岩[1] 王伦青[1] 

机构地区：[1]青岛市人民医院胸心外科,山东青岛266001 [2]青岛大学医学院附属医院胸外科,山东青岛266003

出　　处：《肿瘤防治杂志》2004年第7期732-734,共3页China Journal of Cancer Prevention and Treatment

摘　　要：为探讨肺癌合并中 -重度COPD手术前后肺功能的变化与处理措施。 14例患者 ,经综合治疗肺功能改善后行肺叶切除术 6例 ,肺段切除术 5例 ,肺楔形切除加肺减容术 3例。术后 9例给予机械辅助通气 ,15d后定期复查肺功能 ,围手术期针对性给予抗感染、化痰、解痉、平喘、吸氧及呼吸物理学治疗。结果 :术前肺功能经治疗MVV(L)由3 6 18± 3 74增至 40 76± 4 67,FEV1 0 (L)由 0 89± 0 11增至 1 0 4± 0 13 ,P均 <0 0 1,FVC(L)由 1 44± 0 2 1增至 1 65± 0 2 8,P <0 0 5。术后 1例死亡 ,手术成活率为 92 86% ( 13 /14 )。术后 15d肺功能复查 ,MVV下降至 3 5 3 4± 3 98,FEV1 0 降至 0 82± 0 10 ,P均 <0 0 1;FVC降至 1 3 9± 0 2 0 ,P <0 0 5。 3 0d时MVV为 3 7 0 1± 4 2 4、FEV1 0 为 0 93±0 13、FVC为 1 43± 0 2 2 ,P均 <0 0 5 ;均低于术前水平。恢复至 3个月时 3项指标分别为 42 0 8± 3 62、1 12± 0 13和1 63± 0 2 7,P均 >0 0 5 ;均已达术前水平。 6个月后MVV和FEV1 0 各为 5 90± 4 12和 1 2 1± 0 19,P <0 0 5 ;较术前有所改善 ,而FVC为 1 76± 0 2 8,较术前差异无统计学意义 ,P >0 0 5。The objective of this study is to investigate the lung function change and management in lung cancer combined with moderate-severe chronic obstructive pulmonary disease (COPD) before and after surgical treatment. Fourteen patients received thoracic surgery after they received general treatment and their lung function improved. Among which 6 cases received lobectomy, 5 segmentectomy,3 wedge resection with lung volume reduction. nine cases were administered with mechanical ventilation after surgery. The lung function was reexamined according to the schedule on the 15th postoperative day. All patients received the treatment of antibiotics, phlegm reducing, brochodilator dosages,oxygen inhaling and respiratory physiotherapy in peri-operative period.Preoperative lung function improved significantly after treatment, MVV(L) from 36.18±3.74 to 40.76±4.67,P<0.01, FEV 1.0(L)from 0.89±0.11 to 1.04±0.13,P<0.01, FVC(L)from 1.44±0.21 to 1.65±0.28,P< 0.05.One case died,and the operational survival rate was 92.86%. The postoperative lung function decreased significantly on the 15th day, MVV was 35.34±3.98 and FEV 1.0 0.82±0.10,P<0.01, FVC 1.39±0.20,P<0.05. MVV, FEV 1.0 and FVC were 37.01±4.24, 0.93±0.13, and 1.43±0.22 on 30th postoperativeday,and they were lower than those before operation,P<0.05. However, 3 months later, they were 42.08±3.62, 1.12±0.13 and 1.63±0.27, all indexes could return to the level of preoperation,P>0.05; 6 months later, MVV and FEV 1.0 were 45.90±4.12 and 1.21±0.19, better than preoperation,P<0.05,P<0.05, while FVC was 1.76±0.28, remained stable,P>05.[

关 键 词：肺肿瘤/外科学 肺疾病 阻塞性/外科学 肺切除术 慢性病 肺容量测定 

分 类 号：R734.2[医药卫生—肿瘤]