余肺切除治疗肺部疾患临床分析  

Clinical analysis of completion pneumonectomy for pulmonary disease

作　　者：褚向晖[1] 张逊[1] 王嵩[1] 卢喜科[1] 王学勤[1] 王扩建[1] 

机构地区：[1]天津市胸科医院胸外科,300051

出　　处：《中华外科杂志》2007年第16期1132-1135,共4页Chinese Journal of Surgery

摘　　要：目的探讨余肺切除的手术适应证、手术方法、并发症防治和远期疗效。方法回顾1985年1月至2006年8月进行的24例余肺切除[占同期全肺切除的2.3%(24/1026)]患者的临床资料。余肺切除距第1次肺切除的时间为5.5个月～30年,平均65个月;肺癌复发患者间隔时间为术后5.5个月～10年,平均32个月。手术历时4～7 h,平均5.5 h;术中失血300～3000 ml,平均1270ml。结果手术切除23例,切除率为95.8%。术后并发症发生率及住院死亡率分别为29.2%(7/24)和4.2%(1/24)。术后病理诊断为支气管扩张症2例、原发性肺癌4例、复发性肺癌18例。术后随访率为91.7%(22/24)。肺癌余肺切除患者的1、3、5年生存率分别为77.3%(17/22)、50.0%(9/18)和29.4%(5/17);其中复发性肺癌患者余肺切除术后的1、3、5年生存率为72.2%(13/18)、47.1%(8/17)和29.4%(5/17)。结论严格选择患者,术中精细操作,做好围手术期并发症的防治,余肺切除可有效延长患者的生存期。Objective Completion pneumonectomy （CP） is widely known to be associated with a high morbidity and mortality. However, in certain instances, CP offers the only chance for a cure. Now to explore the indications, preventions and managements of complications as well as late outcomes of CP. Methods During a period of 21 years from January 1985 to August 2006, 24 patients received CP, representing 2.3% of 1026 patients who had undergone pneumonectomy in the same period. There were 17 right and 7 left CPs done in 20 male and 4 female patients with an average age of 58 years （ range from 42 to 67 years）. Lung malignancy accounted for 22 of these cases in which the indication included local recurrence in 18, second primary tumors in 2 and primary malignancies that developed after right upper lobectomies for pulmonary tuberculoma and pulmonary cyst respectively in 2 cases. Benign disease was progression or recurrence of bronchiectasis in 2 cases. Before CP, 17 patients had had a lobectomy, 5 a bilobectomy, 1 sleeve lobectomy and 1 wedge resection. There were 16 of 20 lung cancer patients receiving postoperative chemotherapy and 3 with positive residues having radiotherapy. The mean interval between the two procedures was 65 months for the whole group （5.5-360） and 32 months for lung cancer patients（5. 5- 120）. They all underwent CP,included sleeve CP in 1 patient. Results For all patients, the previous thoracotomy incision was reopened and maneuvers such as rib resection, intrapericardial blood vessel ligation, division of the bronchus first, local application of glues and hemostatic agents, and bronchial reinforcement were routinely used. Intrapericardial route was used in 10 patients （41.7%）. Two patients had right pulmonary artery injured. The operation lasted 4 - 7 hours, with blood loss of 300 to 3000 ml. Overall respectability,morbidity and hospital mortality were 95.8%, 29. 2% and 4. 2%. No intraoperative deaths occurred. There was 1 early postoperative death after 40 days from adult respiratory

关 键 词：手术后并发症 预后 余肺切除 

分 类 号：R655.3[医药卫生—外科学]