慢性阻塞性肺病对肺癌术后肺功能改变的影响及肺灌注扫描术前评估的价值  

Influence of chronic obstructive pulmonary disease on postoperative lung function of lung cancer patients and predictive value of lung perfusion scan

作　　者：廖伟[1,2] 马刚[1,2] 方翼[1,2] 王春梅[1,2] 

机构地区：[1]华南肿瘤学国家重点实验室,广东广州510060 [2]中山大学肿瘤防治中心ICU,广东广州510060

出　　处：《癌症》2009年第6期642-646,共5页Chinese Journal of Cancer

摘　　要：背景与目的:肺癌患者肺切除术后残留肺功能与其预后密切相关。本研究探讨慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)对非小细胞肺癌患者肺叶切除术后肺功能改变的影响,以及肺灌注扫描在伴COPD肺癌患者术前预测的价值。方法:回顾性分析65例因非小细胞肺癌行肺叶切除术的肺癌患者。伴COPD肺癌组25例,肺功能正常肺癌组40例。分别比较两组间手术前及术后30天第一秒用力呼气量(forced expiratory volume in 1st second,FEV1)的改变以及两组间术后FEV1实测值(postoperative FEV1)同术前预测术后FEV1(preoperative predictive postoperative FEV1,ppoFEV1)的差值和比值。对有肺灌注扫描的10例伴COPD肺癌患者单独比较肺灌注扫描ppo’FEV1和公式法ppoFEV1。结果:伴COPD组肺叶切除术后FEV1平均损失百分比小于正常肺功能组(8.98%vs.22.47%,P<0.05);术后30天实测FEV1同术前预测术后FEV1差值(postoperative FEV1-ppoFEV1)大于对照组(6.90vs.0.83,P<0.05);postoperative FEV1/ppoFEV1比值大于对照组(1.14vs.1.01,P<0.05)。行肺灌注扫描的10例伴COPD患者相应的ppo’FEV1-ppoFEV1均数为4.04%,95%置信区间为3.01%～5.07%。结论:伴COPD的肺癌患者肺叶切除后的肺功能损失少于肺功能正常肺癌患者,行肺灌注扫描可能更好地预测伴COPD的肺癌患者肺叶切除术后肺功能。Background and Objective. Postoperative lung function related to the prognosis of lung cancer patients after Iobectomy is closely This study was to explore the influence of chronic obstructive pulmonary disease （COPD） on postoperative lung function in patients undergoing Iobectomy for non-small cell lung cancer （NSCLC）, and to assess the predictive value of lung perfusion scan for lung cancer patients with COPD before operation.Methods. Clinical data of 65 NSCLC patients who underwent Iobectomy were analyzed, Of the 65 patients, 25 had CQPD （COPD group） and 40 had normal lung function （control group）. The change of forced expiratory volume in 1st second （FEV1） after Iobectomy and deference between postoperative FEV1 and preoperative predictive postoperative （ppo） FEVl were compared between the two groups. For ten patients with COPD who had undergone lung perfusion scan before operation, ppo＇FEVl by lung perfusion scan and ppoFEV1 by equation were compared. Results. The mean percent loss of FEVl was less in COPD group than in control group （8.98% vs. 22.47% ,P〈0.05）. The value of postoperative FEV1 minus ppoFEV1 and the ratio of postoperative FEV1 to ppoFEV1 were significantly higher in COPD group than in control group （6.90 vs. 0.83, P〈0.05; 1.14 vs. 1.01, P〈O.05）. For the ten patients undergone lung perfusion scan, the mean value of ppo＇FEVl minus ppoFEVl was 4.04% , with a 95% confidence interval of 3.01%-5.07%. Conclusions. The mean loss of lung function after iobectomy is less in lung cancer patients with COPD than in patients with normal lung function. Lung perfusion scan before operation may help to predict postoperative lung function of lung cancer patients with COPD.

关 键 词：慢性阻塞性肺病 肺肿瘤 肺功能 肺叶切除术 肺灌注扫描 

分 类 号：R734.2[医药卫生—肿瘤]