自体心包奇静脉补片肺动脉重建对中心型肺癌患者术后并发症和预后的影响  

Effect of Pulmonary Artery Reconstruction with Autologous Pericardial or Azygos Vein Graft Patch in Patients with Central Lung Cancer

作　　者：赵振山[1] 李海洋[1] 赵振兴[1] 代岱[1] 郝孟辉[1] ZHAO Zhen-shan;LI Hai-yang;ZHAO Zhen-xing;DAI Dai;HAO Meng-hui(Department of Cardiothoracic Surgery,Kailuan General Hospital,Tangshan 063000,Hebei,China)

机构地区：[1]唐山市开滦总医院心胸外科,河北唐山063000

出　　处：《中国现代手术学杂志》2018年第4期285-290,共6页Chinese Journal of Modern Operative Surgery

基　　金：唐山市科技计划项目(编号:14130228a)

摘　　要：目的探究以自体心包、奇静脉补片行肺动脉重建对于中心型肺癌患者术后并发症和预后的影响。方法回顾性分析2013年1月至2015年1月间于我院行手术治疗的98例肺癌患者的临床资料,根据手术方式分为全肺切除组(47例)和肺动脉重建组(51例),分别行全肺切除术和肺叶切除术+自体心包、奇静脉补片肺动脉重建术,比较两组患者手术前后肺功能情况,包括一秒用力呼气容积(forced expiratory volume in one second,FEV1),用力肺活量(forced vital capacity,FVC),每分钟最大通气量(maximal voluntary ventilation,MVV),肺一氧化碳弥散因子(transfer factor for carbon monoxide of lung,TLCO),手术情况,术后并发症发生率和生存率。结果手术前,两组患者FEV1、FVC、MVV和TLCO无统计学差异(P=0. 947,0. 710,0. 608,0. 858),手术后2个月,两组患者上述指标显著低于手术前(P <0. 05),而肺动脉重建组的上述指标显著高于全肺切除组(均为P <0. 001);肺动脉重建组患者的手术时间、术中出血量、术后胸腔引流量、术后下地时间以及住院时间显著低于全肺切除组(P=0. 027或P <0. 001),两组患者术中淋巴结清除数目无统计学差异(P=0. 440);肺动脉重建组术后并发症发生率显著低于全肺切除组(9. 80%vs. 25. 53%,P=0. 040);两组患者的总生存率无统计学差异(HR=0. 522,95%CI[0. 241,1. 130],P=0. 095);肺动脉重建组患者的无进展生存率明显高于全肺切除组(HR=0. 471,95%CI[0. 237,0. 935],P=0. 031)。结论以自体心包、奇静脉补片行肺动脉重建可以显著改善患者肺功能,手术创伤小,术后恢复快,术后并发症少,并能改善预后。Objective To investigate the effect of pulmonary artery reconstruction with autologous pericardial or azygos vein graft patch on postoperative complications and prognosis of patients with central lung cancer. Methods The clinical data of 98 patients with lung cancer who underwent surgical treatment in our hospital from January 2013 to January 2015 were retrospectively analyzed. According to the surgical methods, they were divided into the pneumonectomy group （47 cases） and the pulmonary artery reconstruction group （51 cases）. The pulmonary function such as forced expiratory volume in one second（FEV1）, forced vital capacity（FVC）, maximal voluntary ventilation（MVV）, transfer factor for carbon monoxide of lung（TLCO）, and operative related indicators, postoperative complications and survival rates were compared between the two groups.Results There was no significant difference in FEV1, FVC, MVV and TLCO between the two groups before operation （ P =0.947,0.710,0.608,0.858）. The above indexes significantly decreased in the two groups 2 months after operation （ P 〈0.05）, and the above indexes in the pulmonary artery reconstruction group were significantly higher than that of the pneumonectomy group （ P 〈0.001）. Operation time, intraoperative bleeding volume, thoracic drainage volume, postoperative off-bed interval and hospitalization time of the pulmonary artery reconstruction group were significantly lower than that of the total pneumonectomy group （ P =0.027 or P 〈0.001）. There was no significant difference in the number of lymph node clearance between the two groups （ P =0.440）. The incidence of postoperative complications in pulmonary artery reconstruction group was significantly lower than that of the pneumonectomy group （9.80% vs. 25.53%, P =0.040）. There was no significant difference in the total survival rate between the two groups （HR=0.522, 95%CI [0.241,1.130], P =0.095）, and the progression free survival rate in the pulmonary artery reconstruction

关 键 词：自体心包补片移植 奇静脉补片移植 肺动脉重建 肺肿瘤 并发症 预后 

分 类 号：R734.2[医药卫生—肿瘤]