局部肺循环临时阻断在复杂肺切除术中的应用

目的探讨局部肺循环临时阻断在复杂肺切除术中的应用价值和技术细节。方法接受局部肺循环临时阻断条件下的肺切除手术24例,12例接受支气管、肺动脉、静脉联合成形术,其中4例为支气管肺动脉“双袖”成形术;10例肺动脉成形或同时联合肺静脉成形（其中1例联合左心房成形术）;2例单纯肺动脉、静脉阻断切除肺叶或全肺。在“双袖”成形术中采用左房血反流氧合残肺。结果术后30 d内死亡2例,死亡原因分别为右全肺切除术后呼吸衰竭和肺动脉成形术后急性肺动脉栓塞。4例接受“双袖”成形术的患者术后均产生不同程度的残肺水肿,术后14-18 d完全恢复。发生脓胸1例（4.2%）,肺炎6例（25.0%）,漏气3例（12.5%）。Ⅰ-Ⅱ期肺癌患者中位生存期为36个月,ⅢA期患者中位生存期为18个月。结论局部肺循环临时阻断在复杂肺切除术中的应用能降低术中风险,简化操作程序,达到最大限度保留健康肺组织和最大限度切除癌肿的目的,有临床实用价值。

Pulmonectomy with Temporary Block of Regional Lung Blood Circulation

Objective To evaluate the efficacy of the regional pulmonary circulation block technique during the complex pulmonectomy. Methods 24 patients underwent pulmonectomy with regional pulmonary circulation block technique, in which 12 patients underwent combined broncho-angioplasties （among them, 4 patients received bronchial-vascular double sleeve resection） , 10 patients underwent combined plasty of pulmonary artery and vein, and 2 patients received pneumonectomy with regional pulmonary circulation block. During the double sleeve resection, the blood of the left atrium was backstreamed to oxygenate the residuary lung. Results Two patients died due to the pulmonary insufficiency and pulmonary artery thrombosis after angioplasty. The edema of left lower lobe occurred in 4 patients after the double-sleeve broncho-angioplasties. However, all of them were recovered in 14 to 18 days postoperatively. The other complications included 1 （4.2%） of empyema, 6 （25.0%） of pneumonia, and 3 （12.5%） of air leakage. The mean survival time was 36 months and 18 months for patients with stage Ⅰ - Ⅱ and IliA lung cancer respectively. Conclusion The pulmonectomy with regional blood circulation block is a valid and safe technique for patients with stage Ⅰ and Ⅱ central type lung cancer and lung benign lesions, which can make the operation possible to remove cancer and remain the healthy lung tissue maximatily.