肺癌合并肺纤维化患者在肺癌根治术中手术风险的评估  

Risk assessment of lung cancer combined with pulmonary fibrosis in lung cancer radical surgery

作　　者：王硕[1] 张军[1] 严一杰 孟繁杰 关志宇[1] WANG Shuo;ZHANG Jun;YAN Yi-jie;Meng Fan-jie;GUAN Zhi-yu(Department of Thoracic Surgery, The Second Hospital ,Tianjin Medical University, Tianjin 300211,China)

机构地区：[1]天津医科大学第二医院胸外科,天津300211

出　　处：《天津医科大学学报》2018年第2期156-158,161,共4页Journal of Tianjin Medical University

基　　金：天津市卫计委重点攻关项目基金资助(15KG138)

摘　　要：目的:分析肺癌合并肺纤维化患者肺癌根治术的预后,并探讨此类患者手术风险的评估。方法:回顾性分析373例肺癌患者行肺切除术的病理组织,以是否有肺纤维化分为两组(I组和Ⅱ组),对二者术后并发症、临床转归、生存率等相关指标进行比较,并按照不同手术切除方式进行亚组分析。结果:在所有373个标本中,有21例确诊为肺纤维化,两组在年龄[(65±12)岁vs(64±9)岁]、吸烟史(76%vs 63%)、1秒钟用力呼气容积[(2.41±1.25)L·min^(-1) vs(2.49±1.38)L·min^(-1)]、用力肺活量[(3.08±1.53)Lvs(3.44±1.42)L]没有显著差异,但肺纤维化患者男性更多(71%vs 51%,P<0.05)。肺纤维化患者的手术死亡率高于对照组(14%vs 4%,P<0.01),亚组分析显示肺纤维化患者全肺切除术(20%vs 9%,P<0.01)和肺叶切除术(13%vs 4%,P<0.01)死亡率较对照组高。肺纤维化患者术后肺损伤发生率较高(42%vs 5%,P<0.01),住院时间较长[(15.70±4.11)d vs(9.28±3.03)d,P<0.05]。在肺纤维化患者中,5例患者出现术后急性呼吸窘迫综合征,其中3例死亡。术后急性呼吸窘迫综合征的发生与术前低DLCO[(4.01±1.40)mmol·min^(-1)·k Pa^(-1)·L^(-1),(4.5±1.65)mmol·min^(-1)·k Pa^(-1)·L^(-1),P<0.05]和KCO[(0.92±0.33)mmol·min^(-1)·k Pa^(-1)·L^(-1),(1.01±0.46)mmol·min^(-1)·k Pa^(-1)·L^(-1),P<0.05]以及高术前CPI(45.68±7.41,32.22±17.21,P<0.01)有关。结论:肺纤维化患者行肺癌根治术术后发病率和死亡率增加,与术前低气体弥散指标和高CPI有关。术前仔细评估其肺功能受损程度以选择合适的病人,对其行肺癌切除术的生存获益是十分必要的。Objective:To analyze the prognosis of patients with lung cancer combined with pulmonary fibrosis in lung cancer radical surgery and to evaluate the surgical risk of these patients.Methods:Making retrospective analysis on patients’lung tissue(2010-2016),which were divided into two groups based on pulmonary fibrosis(I andⅡgroup).The postoperative complications,clinical outcomes,survival rates and other related indicators were compared,and subgroup analysis was performed by different surgical excision methods.Results:In all373cases,21cases were diagnosed with pulmonary fibrosis,the two groups showed no significant differences in age[(65±12)years old vs(64±9)years old],smoking(76%vs63%),forced expiratory volume in1second[(2.41±1.25)L·min-1vs(2.49±1.38)L·min-1],forced vital capacity[(3.08±1.53)L vs(3.44±1.42)L].However,there were more male patients with pulmonary fibrosis(71%vs51%,P<0.05).The procedure showed that the mortality rates of patients with pulmonary fibrosis were higher than the control group(14%vs4%,P<0.01).Subgroup analysis showed that the mortality rates in patients with pulmonary fibrosis of pneumonectomy(20%vs9%,P<0.01)and lobectomy(13%vs4%,P<0.01)were higher than the control group.The incidence of acute lung injury in patients with pulmonary fibrosis was higher(42%vs5%,P<0.01),and the length of hospitalization was longer(15.70±4.11vs9.28±3.03days,P<0.05).In patients with pulmonary fibrosis,5patients had postoperative acute respiratory distress syndrome,3of which were fatal.Postoperative acute respiratory distress syndrome occurred with preoperative low DLCO[(4.01±1.40)mmol·min-1·kPa-1·L-1,(4.5±1.65)mmol·min-1·kPa-1·L-1,P<0.05]and KCO[(0.92±0.33)mmol·min-1·kPa-1·L-1,(1.01±0.46)mmol·min-1·kPa-1·L-1,P<0.05],as well as the high preoperative CPI(45.68±7.41,32.22±17.21,P<0.01).Conclusion:The incidence and mortality of postoperative patients with lung fibrosis combined with non-small cell lung cancer are increased due to low preoperative gas dispersion and high CPI.In patients

关 键 词：肺纤维化 非小细胞肺癌 肺癌根治术 

分 类 号：R734.2[医药卫生—肿瘤]