肺通气/灌注显像预测肺癌术后肺功能

目的 利用肺通气/灌注显像预测肺癌切除术后残余肺功能及评价手术适应证.方法 26例原发性肺癌患者：21例行肺灌注/通气显像,其中13例行手术治疗;5例行肺灌注显像行手术治疗;所有患者于术前1周左右行肺功能检查,其中18例手术治疗患者于术后2个月再次行肺功能检查.采用Neuhaus公式计算术后肺功能：第1秒用力呼气量预测值（ppoFEV1）.对通气、灌注显像2种方法计算所得的ppoFEV1值进行t检验,并分别与术后2个月肺功能实测值进行t检验和相关性分析.结果 21例患者通气法ppoFEV1为（1.347±0.539）L,灌注法ppoFEV1为（1.410±0.543）L,差异无统计学意义（t=0.062,P＞0.05）;13例手术者其中术前通气ppoFEV1为（1.545±0.588）L,术后2个月实测值为（1.450±0.521）L,差异无统计学意义（t=0.092,P＞0.05）.所有18例手术者术前灌注ppoFEV1为（1.697±0.546）L,术后2个月实测值为（1.457±0.488）L,差异无统计学意义（t=0.017,P＞0.05）.13例肺通气法ppoFEV1与术后2个月实测值显著相关,r=0.950,P＜0.01;肺灌注法ppoFEV1值与术后2个月实测值也显著相关,r=0.937,P＜0.01.18例肺灌注法ppoFEV1与术后2个月实测值也显著相关（r=0.922,P＜0.01）.结论 肺通气/灌注显像结合肺功能测定有利于判断肺癌患者尤其合并低肺功能患者能否进行手术及确定手术部位和范围,能用于预测肺癌切除术后残余肺功能.

Predictive value of ventilation and perfusion scintigraphy for the postoperative pulmonary function in patients with lung cancer

Objective To evaluate the value of ventilation and perfusion scintigraphy for predicting the postoperative pulmonary function in patients with lung cancer. Methods Twenty-six patients with lung cancer, male 21 and female 5, aged from 44 to 86 ys, were recruited into the study. Before surgery, 21 patients underwent 99Tcm-DTPA aerosol ventilation and 99Tcm-macroaggregated albumin ( MAA ) perfusion scintigraphic imaging. The other five patients were studied with perfusion imaging only. Pulmonary function was measured as forced expiratory volume in the first second ( FEV1 ) at about one week before surgery for all patients, and at two months after surgery. The predicted postoperative FEV1 ( ppoFEVt ) was calculated by Neuhaus' formula based on the ventilation or perfusion function obtained from scintigraphy studies, and compared with the measured post surgery FEV1. Eighteen patients underwent the surgical resection successfully. The t-test and correlation analysis were used. Results The ppoFEV1 values of ventilation and perfusion were (1.347±0.539) Land (1.410±0.543) L, respectively (n=21, t =0.062, P＞0. 05). Both the ppoFEV1 values of ventilation and perfusion showed no significant difference with the respective post-surgeryFEV1(n=13, (1.545 ±0.588) Lvs (1.45 ±0.521) L, t=0.092, P＞0.05; n=18, (1.697±0. 546) L vs ( 1.457±0.488) L, t =0. 017, P ＞0.05, respectively). Both the ventilation ppoFEV1 (n =13) and perfusion ppoFEV1 (n = 13, n = 18) correlated well with the post-surgery FEV1 respectively (r =0. 950, 0. 937, 0. 922, all P ＜ 0. 01 ). Conclusion Ventilation and perfusion imaging can predict the postoperative pulmonary function for patients with lung cancer, especially for those with borderline pulmonary function, thus useful for selection of suitable candidates for surgical resection.