胸部难治性肿瘤个体化体外循环技术应用策略  

Individual strategies for the application of extrcorporeal circulation technique in the surgical treatment of refractory thoracic tumors

作　　者：沈育美 朱蓉英[1] 段善州[1] 杨文涛[1] 陈勇兵[1] 陈磊[1] Shen Yumei;Zhu Rongying;Duan Shanzhou;Yang Wentao;Chen Yongbing;Chen Lei(Department of Thoracic Surgery,the Second Affiliated Hospital of Soochow University,Jiangsu Suzhou 215004,China)

机构地区：[1]苏州大学附属第二医院胸心外科,苏州215004

出　　处：《中国体外循环杂志》2022年第5期285-289,共5页Chinese Journal of Extracorporeal Circulation

基　　金：江苏省科技厅社会发展-重点项目(BE2020653);苏州市胸部肿瘤重点实验室项目(SZS201907);苏州市科技发展(民生科技)项目(SS2019061);苏州大学附属第二医院学科建设托举工程项目(XKTJ-XK202004)。

摘　　要：目的 探讨胸部难治性肿瘤手术治疗过程中应用个体化体外循环(ECC)技术的实践策略。方法 回顾本中心自2008年1月至2021年11月期间在ECC下完成的难治性巨大胸部肿瘤15例,收集疾病临床特征及手术方式,术中ECC辅助时间、术后ICU入住时间、术后并发症、术后住院时间,以及术后肿瘤复发及转移情况。结果 15例胸部难治性肿瘤患者在ECC辅助下完成了肿瘤的切除手术,其中11例(73.3%)术中完全切除肿瘤组织。肿瘤切除过程中ECC平均转流时间为(94.8±28.5)min。术后平均ICU停留时间为(1.8±0.8)d,术后平均住院时间为(18.4±4.6)d。术后发生并发症3例,其中1例患者发生凝血功能障碍,1例患者发生早期支气管胸膜瘘,1例患者发生严重肺部感染,无中枢神经系统并发症发生。术后30 d内无患者死亡。共有13例患者术后规律随访(肿瘤完全切除11例,未完全切除2例),3例发生远处转移(肿瘤完全切除1例,未完全切除2例),4例发生局部复发(肿瘤完全切除2例,未完全切除2例)。随访过程中共有4例患者死亡(肿瘤完全切除2例,未完全切除2例)。结论 术前经过缜密的多学科讨论,术中采用个体化的ECC技术策略和体外全身热疗,有助于完全切除肿瘤并获得良好的预后。Objective To explore the individual strategies of extrcorporeal circulation(ECC) technique in the surgical treatment of refractory thoracic tumors.Methods Clinical data of patients with refractory thoracic tumors who underwent surgery under ECC in the Second Affiliated Hospital of Soochow University between January 2008 and November 2021 were retrospectively reviewed.Results A total of 15 patients with refractory thoracic tumors underwent tumor resection with the assistance of ECC,of which 11 cases(73.3%) were completely resected.The mean ECC time during tumor resection was 94.8±28.5 min.The mean postoperative ICU stays and postoperative hospital stays was 1.8±0.8 d and 18.4±4.6 d,respectively.Postoperative complications occurred in 3 patients(1 case of coagulation dysfunction,1 case of early bronchial pleural fistula,and 1 case of severe lung infection) without complications of central nervous system.And no patient died within 30 days after surgery.Of the 13 patients with postoperative followed up(patients of complete resection vs patients of incomplete resection = 11 vs.2),3 patients suffered distant metastasis(patients of complete resection vs patients of incomplete resection = 1 vs.2),and 4 patients suffered local recurrence(patients of complete resection vs patients of incomplete resection = 2 vs.2).Four patients died(patients of complete resection of tumor vs patients of incomplete resection = 2 vs.2) during the follow-up.Conclusion Preoperative multidisciplinary consultation and standardized application of individual ECC strategies can help surgeons to effectively maintain the stability of respiratory and circulation systems,and may achieve a complete removal of refractory thoracic tumors with favorable prognosis.

关 键 词：胸部肿瘤 胸外科手术 体外循环 体外全身热疗 个体化治疗 

分 类 号：R730[医药卫生—肿瘤]