肺癌外科切除术后死亡率的近期结果

背景 日本东京癌症专科医院对近16年肺癌切除术后死亡率的变化和死亡原因进行调研。方法国家癌症中心医院将1987年2月至2002年12月间行肺切除的3270例原发肺癌的病人资料进行了回顾性分析。对肺癌切除术后30天和住院期间死亡率及死亡原因进行了调研。病人被分成近乎等数的两组，早期组(从1987年至1996年1,615例)和近期组(从1997年至2002年1，655例)。     

食管贲门癌围手术期死亡原因分析及对策

1996年1月至2002年12月,我院施行食管癌切除术725例、贲门癌切除术473例,手术死亡28例(2．34％),其中食管癌19例,贲门癌9例,分别占2．62％、1．90％。现对死亡原因进行分析,并探讨预防措施。     

16例心脏瓣膜置换术后患者死亡原因分析

目的分析心脏瓣膜置换术后患者围手术期死亡原因,探讨降低死亡率的措施。方法对1998年10月至2012年3月我科施行的心脏瓣膜置换术后16例围手术期死亡患者的死亡原因进行回顾性总结和分析。结果术中死亡4例,包括低心排出量综合征（LCOS）不能停体外循环2例,主动脉口血1例,早期左心室破裂1例。其他12例死于术后3h至27d,其中LCOS4例、迟发型左心室破裂2例、肾功能衰竭2例、呼吸功能衰竭2例、甲亢危像1例。结论术前进行有效的针对性治疗,术中尽可能缩短手术及体外循环时间,减少手术意外,积极、有效地预防和处理并发症的发生,是降低心脏瓣膜置换术后死亡率的关健。     

胰十二指肠切除术后围手术期死亡原因分析

目的：分析胰十二指肠切除术后围手术期死亡的常见原因和探讨降低其死亡率的防治措施。方法：回顾性分析我院1961年6月至2002年6月胰十二指肠切除术死亡病例资料。结果：共有307例患施行了胰十二指肠切除术，术后有21例患死亡，死亡率为6．8％，以1986年为界将行胰十二指肠切除术患分为2个阶段，手术死亡率第1阶段为14．7％（11／75），第2阶段为4．3％（10／232）（P＜0．01），死亡原因为消化道出血（5例）、腹腔内出血（5例）、胰瘘（4例）、多器官功能衰竭（3例），ARDS（2例），腹腔感染（1例）及胆瘘（1例）。结论：胰十二指肠切除术后围手术期死亡的主要原因是消化道或胜利腔内出血，胰瘘，多器官功能衰竭等，加强围手术期处理，术前进行重要脏器功能的合理评估，配备具有丰富经验的专科和完善外科操作技术，提高重并发症的处理水平，可显降低胰十二指肠切除术的围手术期死亡率。     

胰十二指肠切除术后围手术期死亡原因分析

目的分析胰十二指肠切除术后围手术期死亡的常见原因和探讨降低其死亡率的防治措施.方法回顾性分析我院1961年6月至2002年6月胰十二指肠切除术后死亡病例资料.结果共有307例患者施行了胰十二指肠切除术,术后有21例患者死亡,死亡率为6.8%.以1986年为界将行胰十二指肠切除术患者分为2个阶段,手术死亡率第1阶段为14.7%(11/75),第2阶段为4.3%(10/232)(P<0.01).死亡原因为消化道出血 (5例)、腹腔内出血(5例)、胰瘘(4例)、多器官功能衰竭 (3例),ARDS(2例),腹腔感染(1例)及胆瘘 (1例).结论胰十二指肠切除术后围手术期死亡的主要原因是消化道或腹腔内出血、胰瘘、多器官功能衰竭等.加强围手术期处理,术前进行重要脏器功能的合理评估,配备具有丰富经验的专科医生和完善外科操作技术,提高严重并发症的处理水平,可显著降低胰十二指肠切除术的围手术期死亡率.     

肺切除术后心律失常的分析

心律失常是肺切除术后常见的并发症。我们探讨了肺切除术后心律失常相关的一些因素。 资料与方法 2004年6月至2006年6月，我们共施行肺疾病手术86例，其中男53例，女33例；年龄〈50岁31例，50～69岁之间49例，70岁以上5例，良性病例12例，     

肺切除术围术期血液保护的应用体会

自2003年以来，我院胸外科对398例行肺切除术的患者采用围术期血液保护措施，取得较好效果，现报告如下。     

主动脉瘤围术期死亡原因的临床分析

对２７３例各种主动脉瘤围手术期死亡患者进行分析。全组总的死亡率为２０．１％。结果提示，随着年代不同，围术期死亡率逐年减低。感染性主动脉瘤死亡率（３６．２％）明显高于非感染性主动脉瘤。急诊手术围术期死亡率（４３％）明显高于择期手术。４０岁左右年龄组是各种动脉瘤死亡率最低年龄组，５５岁以上年龄组死亡率明显增高。各种主动脉庙临床表现均以胸痛或腹痛居多，当同时伴有咯血、吞咽困难等症状时，围术期死亡率明显增高。各种术后并发症以低心输出量综合征、多脏器功能衰竭、出血及肾功能衰竭等多见，当同时伴有上述并发症时，死亡率明显增高。     

182例围产儿死亡原因分析

目前 ,在我国围产儿死亡率平均为 2 6 .6 5‰ ,明显高于先进国家或地区 (一般小于 10‰ )。我们对近 3年来我院 182例死亡围产儿的死亡原因进行了分析 ,以便采取针对性干预措施 ,降低围产儿死亡率。临床资料 :1999年 1月至 2 0 0 1年 12月在我院分娩新生儿共 14 5 97例 ,其中围产期死亡 182例 (包括死胎 70例 ,死产5例 ,生后 7天内死亡 10 7例 ) ,死亡率 12 .4 7‰。其中 1999年死亡率为 18.2 0‰ (6 9/ 3792 ) ,2 0 0 0年为 10 .86‰ (5 6 / 5 15 6 ) ,2 0 0 1年为 10 .0 9‰ (5 7/ 5 6 4 9)。分娩时 2 8～ 37孕周者围产儿死亡率为 2 39.2 …     

肺切除术后患者苏醒期的护理

2005年6月～2006年12月,本院共行肺切除术112例,术后患者顺利苏醒.现将苏醒期的护理方法介绍如下.     

肺切除术前肺功能与术后并发症的关系探讨

目的　探讨术前肺功能与肺切除术后并发症的相关关系。方法　对 318例肺切除患者于术前行肺功能检查 ,观察其术后并发症的发生。结果　 76例患者肺切除术后发生并发症 ,1秒钟用力呼气量 (FEV1 )占预计值 %、最大通气量 (MVV)占预计值 %、术后预计 FEV1 (FEV1 - ppo)降低与术后并发症有显著相关性。术前心肺基础疾患亦是术后并发症的高危因素。结论　 FEV1 占预计值 % <70 % ,MVV占预计值 % <5 0 % ,FEV1 - ppo<1.0 L 时 ,全肺切除的危险性增大 ;FEV1 占预计值 % <6 0 % ,MVV占预计值 % <4 0 % ,FEV1 - ppo<1.0 L 时 ,肺叶切除危险性升高。     

肺切除术后并发房颤的发病因素

目的 :探讨肺切除术后并发房颤 (AF)的发病因素 ,提高诊治水平。方法 :回顾性分析 1988年至 1997年间连续 6 48例肺切除术的临床资料。结果 :术后并发AF 2 1例。年老 ,术前伴有 2种以上并存症 ,术中低血压及全肺切除 (尤其是心包内处理肺血管 )术式是术后并发AF的高危因素 (P <0 0 0 1) ;心肌缺氧是并发AF的重要原因。致命性AF少见 ,2 1例经及时诊治均恢复窦性心律 ,无此并发症死亡。结论 :提高肺切除术后并发AF的认识 ,加强防治措施 ,可以把此并发症的危险性减少到最低限度     

Impact of the extent of lung resection on postoperative outcomes of pulmonary metastasectomy for colorectal cancer metastases: an exploratory systematic review

BackgroundPulmonary metastasectomy (PM) with curative intent has become a widely accepted treatment for lung metastases from solid tumours in selected patients, with low perioperative morbidity and mortality. In particular, PM is strongly recommended in selected patients with secondary lesions from colorectal cancer (CRC), due to its excellent postoperative prognosis. Nevertheless, the impact of the extent of PM on recurrence and survival remains controversial. This review aimed at assessing differences in short- and long-term postoperative outcomes depending on the extent of lung resection for lung metastases.MethodsA systematic literature review of studies comparing anatomical and non-anatomical resections of lung metastases was performed (Prospective Register of Systematic Reviews Registration: 254931). A literature search for articles published in English between the date of database inception and January 31, 2021 was performed in EMBASE (via Ovid), MEDLINE (via PubMed) and Cochrane CENTRAL. Retrospective studies, randomised and non-randomised controlled trials were included. The Cochrane Collaboration tool was used to determine the risk of bias for the primary outcome for included studies.ResultsOut of 432 papers, three retrospective non-randomised studies (1,342 patients) were selected for systematic reviewing. Although our search design did not exclude any primary tumour histology, all selected studies investigated surgical resection of lung metastases from CRC. Because of variations in the compared surgical approaches to pulmonary metastases, a meta-analysis proved unfeasible. There was a tendency to perform anatomical resections for larger metastases. Multivariate analyses revealed that anatomical resections were protective for recurrence-free survival (RFS), while the impact of such procedures on overall survival (OS) remained uncertain. A significantly higher incidence of resection-margin recurrences was observed in patients who underwent non-anatomical resections.DiscussionAnatomical resections of lung metastases from CRC seem to be associated with improved RFS. However, well-constructed comparative clinical trials focusing on the extent of PM are needed.     

Meta-analysis of short-term outcomes after laparoscopic resection for rectal cancer

Background Laparoscopic resection (LR) has become increasingly popular for the management of rectal cancer. Despite a decade of experience, the safety and efficacy of LR for rectal cancer remains to be established. This report performs a meta-analysis to compare LR with conventional open resection (CR) in patients with rectal cancer.Methods Using a defined search strategy, studies directly comparing CR with LR for rectal cancer were identified. The data for patients with rectal cancer treated with both approaches were extracted and used in our meta-analysis. Open surgery and laparoscopic surgery were compared in terms of postoperative mortality, morbidity, complications, oncological clearance, operating time, and time before recovery to a normal diet.Results Compared with CR, LR is associated with lower morbidity rates [OR 0.63 (0.41, 1.96) P=0.03], longer operating times [weighted mean difference 1.59 (1.20, 1.98) P<0.00001], similar mortality rates, wound healing disorder rates, urinary disorder rates, cardiopulmony disease rates, all leakage rates, all abscess rates and a positive rate of margin.Conclusion LR is associated with less postoperative morbidity, but longer operation time. A prospective randomized controlled trial is warranted to fully investigate these and other outcome measures.     

高龄肺切除患者术后肺部并发症的分析

目的探讨高龄肺切除患者手术后肺部并发症的发生与预防。方法回顾性分析我院2000年6月～2009年8月63例70岁以上高龄患者肺切除术后发生肺部并发症的25例临床资料。结果本组手术后发生肺部并发症,发生率39.7%,其中肺部感染发生率最高,占52%。手术后死亡3例,围手术期死亡率4.8%。结论高龄肺切除患者术后肺部并发症发生率较高,但是充分的术前准备与评估,操作细致,术后加强监护管理等,都是预防术后肺部并发症的重要措施。     

Electrocardiographic impacts of lung resection

Introduction

Electrocardiographic (ECG) changes accompanying lung resection have not been well investigated previously in a large controlled series of human adults. Thus, our current investigation was undertaken for a better understanding of the ECG changes associated with lung resection.

Materials and Methods

Medical records of 117 patients who underwent lung resection (segmentectomy, lobectomy, or pneumonectomy) were reviewed. Their clinical course and ECGs were compared during early, intermediate and late postoperative course (< 1 month, 1 month to 1 year and > 1 year post-op respectively).

Results

Patients in the acute postoperative phase had higher heart rate, increased maximum P-duration and P-dispersion, increased incidence of atrial arrhythmias and frequent ST-T changes. P-vector and QRS-vector were significantly affected after the lung resections; the correlation being most consistent between the anatomical displacements and the QRS-vector in the majority of patients. The axial shifts also demonstrated a characteristic temporal relationship after left pneumonectomy (a leftward deviation in the acute, normal or slight rightward deviation in the intermediate and a rightward deviation in the late postoperative course). The precordial R/S transition is often affected due to the mediastinal shifts and the ECGs in patients after left lung resection may simulate acute anteroseptal myocardial infarction due to a delayed R/S transition.

Conclusion

The understanding and recognition of the expected ECG findings after lung resection are imperative to avoid confusing these changes with other acute cardiopulmonary events which would prevent unnecessary further investigational work-up. These ECG changes are often dynamic and may bear a temporal relationship to the dynamic post-surgical changes in the thoracic anatomy.     

逆行肺切除的临床应用

目的探讨在特定条件下逆行肺切除的优点。方法在特定条件下,优先处理支气管或在处理肺动脉血管中间适时处理支气管,以期达到提高手术切除率,降低手术风险,简化手术的目的。结果全组病人无围手术期死亡,恢复较好。结论逆行肺切除在临床上可操作性强,较常规肺切除有其优点。     

Lung cancer: Preoperative pulmonary evaluation of the lung resection candidate

Lung resection provides the best chance of cure for individuals with early stage non-small cell lung cancer. Naturally, lung resection will lead to a decrease in lung function. The population that develops lung cancer often has concomitant lung disease and a reduced ability to tolerate further losses in lung function. The goal of the preoperative pulmonary assessment of individuals with resectable lung cancer is to identify those individuals whose short- and long-term morbidity and mortality would be unacceptably high if surgical resection were to occur. Pulmonary function measures such as the forced expiratory volume in 1 second and the diffusing capacity for carbon monoxide are useful predictors of postoperative outcome. In situations in which lung function is not normal, the prediction of postoperative lung function from preoperative results and the assessment of exercise capacity can be performed to further clarify risks. Published guidelines help to direct the order of testing, permitting us to offer resection to as many patients as possible.     

华西医院1996-2004年住院成人糖尿病患者病死率及死因分析

目的了解住院糖尿病（DM）患者病死率、主要死亡原因及其占全院死亡患者构成比的变化情况,为本地区DM的临床流行病学研究提供初步资料。方法利用病案查询系统检索DM患者总出院人数为14670例、全院总死亡人数为9597例,DM患者总死亡人数为842例,并计算DM患者的病死率、死亡原因、死因构成比并与既往或国内外同期报道相比较。结果1996-2004年间我院DM患者病死率为5.74%。DM患者死亡的前6位原因分别为肿瘤（22.3%）、感染（15%）、心血管事件（14.4%）、脑血管事件（12.3%）、慢性阻塞肺疾病（8%）、糖尿病肾病（6.3%）。全院住院患者死亡人群中DM患者所占比例呈明显逐年上升趋势（χ^2=71.9070,P〈0.01）。结论1996-2004年间我院住院患者死亡人群中DM患者所占比例呈明显逐年上升趋势。近年DM患者死因中恶性肿瘤所占比例显著增加应引起重视。     

Liver resection and metabolic disorders: An undescribed mechanism leading to postoperative mortality

AIM: To investigate the mechanism leading to perioperative mortality in patients undergoing major liver resection and presenting with metabolic disorders.METHODS: The link between Metabolic Syndrome and non-alcoholic fatty liver disease is currently demonstrated. Various metabolic disorders and the Metabolic Syndrome (the association of ≥ 3 metabolic disorders) have been recently described as a risk factor of perioperative mortality in major liver resection. Patients who passed away during perioperative course of major liver resection and presenting with the association of ≥ 2 metabolic disorders without any other known cause of liver disorders were reviewed.RESULTS: From January 2001 to May 2010 in a tertiary centre, ten patients presenting with ≥ 2 metabolic disorders without any other known cause of liver disorders died during perioperative course of major liver resection. The same four-consecutive-steps sequence of events occurred, including jaundice. The analysis of this series suggested a rapidly deteriorating congestive liver resulting in an increased portal hypertension leading to hepatorenal syndrome and lately to multiorgan failure (mimicking septic collapse) as the mechanism leading to exitus. The acute portal hypertension is mainly related to the surgical procedure. The chronic portal hypertension is indeterminate. Patients with ≥ 2 metabolic disorders should be considered as potentially presenting with portal hypertension possibly evolving towards hepatorenal syndrome; thus, they should be considered as having a high perioperative risk and should be carefully evaluated before undergoing major liver resection.CONCLUSION: As fibrosis was not present or marginal in liver specimens, the real cause of portal hypertension in patients with multiple metabolic disorders should be investigated with further studies.