胸腔镜下肺叶切除术对早期老年肺癌患者的临床效果

目的探讨胸腔镜下肺叶切除术治疗老年早期肺癌患者临床效果及呼吸功能指标的影响。方法回顾分析2013年12月至2019年12月在本院行肺叶切除术患者86例,分两组各43例。对照组采用开胸手术治疗,观察组则行胸腔镜下肺叶切除术。对比两组患者手术前后的手术指标以及肺功能指标。结果对照组患者术中出血量、手术时间、引流液量、住院总时间均高于观察组(P0.05),术前两组患者肺功能指标用力肺活量(FVC)、第1秒用力呼气量(FEV1)及呼气峰值流速(PEF)比较(P0.05),术后观察组与对照组的FVC、FEV1、PEF同手术前相比降低(P0.05),且观察组FVC、FEV 1、PEF水平高于对照组(P0.05)。结论采用胸腔镜下肺叶切除术治疗老年早期肺癌患者疗效较好,呼吸功能影响较小,无明显不良反应及并发症,利于患者术后康复。     

完全电视胸腔镜肺段与肺叶切除术治疗早期肺癌的临床疗效研究

目的 探讨完全电视胸腔镜手术（VATS）治疗早期肺癌的疗效及安全性。方法 回顾性分析2021年1月至2021年12月于本院行VATS的患者74例的临床资料，依据手术方式不同，分为肺段切除组（37例，行VATS肺段切除术）与肺叶切除组（37例，行VATS肺叶切除术），所有患者术中均接受相应护理干预措施。术后3个月，比较两组手术指标、术前与术后肺功能指标[包括最大通气量（MVV）、用力肺活量（FVC）及第1秒钟用力呼气量与用力肺活量比值（FEV1%）]、皮肤受伤程度及并发症发生率。结果 两组患者术后引流量、淋巴结清扫数相比，差异无统计学意义（P>0.05）；肺段切除组患者的手术时间明显长于肺叶切除组，术中出血量、住院时间明显少/短于肺叶切除组，差异有统计学意义（P<0.05）；术前，两组MVV、FVC、FEV1%水平相比，差异无统计学意义（P>0.05）；术后，肺段切除组MVV、FVC、FEV1%水平明显高于肺叶切除组，差异有统计学意义（P<0.05）；肺段切除组皮肤无反应率高于肺叶切除组，差异有统计学意义（P<0.05）；肺段切除组并发症发生率低于肺叶切除组...     

全胸腔镜肺叶切除对腹型肥胖低肺功能肺癌患者术后心肺功能的影响

目的探讨全胸腔镜肺叶切除对腹型肥胖低肺功能肺癌患者术后心肺功能的影响。方法 2013年7月~2014年6月对23例腹型肥胖伴低肺功能肺癌行全胸腔镜肺叶切除术,观察术后1周内心肺并发症,术前2 d,术后第3、7天,1.5、3、6个月行肺功能检查及登楼试验,评价心肺功能。结果术后心肺并发症发生率39.1%(9/23)。术后第3天较术前FVC[(1.83±0.45)L vs.(2.70±0.68)L,q=7.936,P0.05]、FEV1.0[(1.05±0.29)L vs.(1.75±0.25)L,q=9.745,P0.05]、FEV1.0/FVC[(53.3±7.6)%vs.(70.2±6.0)%,q=9.902,P0.05]、MVV[(55.3±14.9)L/min vs.(86.8±16.5)L/min,q=9.279,P0.05]、FRC[(1.50±0.27)L vs.(2.25±0.35)L,q=8.920,P0.05]明显下降,术后第7天较术前FVC[(2.07±0.53)L vs.(2.70±0.68)L,q=5.747,P0.05]、FEV1.0[(1.35±0.31)L vs.(1.75±0.25)L,q=5.568,P0.05]、FEV1.0/FVC[(57.6±7.4)%vs.(70.2±6.0)%,q=7.382,P0.05]、MVV[(66.3±15.8)L/min vs.(86.8±16.5)L/min,q=6.038,P0.05]、FRC[(1.68±0.35)L vs.(2.25±0.35)L,q=6.779,P0.05]下降明显;术后第7天与第3天比较,FEV1.0[(1.35±0.31)L vs.(1.05±0.29)L,q=4.176,P0.05]、MVV[(66.3±15.8)L/min vs.(55.3±14.9)L/min,q=3.240,P0.05]有统计学差异,在短期内恢复;术后1.5月较术后第3、7天FVC、FEV1.0/FVC、MVV明显好转(P0.05),与术后3、6个月无统计学差异(P0.05),肺功能趋于稳定;FVC、FEV1.0、FEV1.0/FVC、MVV术后6个月与术前比较无统计学差异(P0.05),表明肺功能已恢复到术前水平。登楼试验显示术后第7天仅2例(8.7%)能坚持到5楼,且HR明显升高、登楼时间延长及Sp O2下降均≥5%;术后1.5月登楼成功例数与术前无差异(P0.05),术后3个月仅登楼时间较术前有明显差异(P0.05)。结论腹型肥胖低肺功能肺癌患者行全胸腔镜肺叶切除术后1周对心肺功能影响明显,注意加强围手术期管理,1.5月后心肺功能逐渐代偿,恢复满意。     

系统呼吸训练对肺癌患者术后肺功能的影响

目的 探讨系统呼吸训练对肺癌患者术后肺功能的影响。方法 将152例肺癌术后惠者随机分为观察组（82例）和对照组（70例），对照组行常规胸部术后护理；观察组在此基础下行缩唇呼气训练及深呼吸训练6个月，并于术前、术后2周、3个月、6个月评估两组患者肺功能（FVC，FEV1，FEV1／FVC）。结果 两组术后不同时段肺功能均较术前下降（P〈0．05，P〈0．01）。观察组术后3、6个月肺功能较术后2周显著改善（均P〈0．05）；与对照组同时段比较，差异有显著性意义（均P〈0．05）。而对照组仅FEV1在术后3、6个月有所改善，与术后2周比较，差异有显著性意义（均P〈0．05）。结论 术后呼吸训练能够改善肺癌患者术后肺功能。     

肺癌切除术患者围术期呼吸训练器与腹式呼吸锻炼效果比较

目的探讨肺癌切除术患者围术期安全有效的呼吸锻炼方法,促进患者康复。方法将78例行择期肺癌手术患者分为对照组和观察组各39例。围术期对照组行缩唇呼吸结合腹式呼吸功能锻炼;观察组采用呼吸训练器进行呼吸功能锻炼。每天1次,持续7d后评价效果。结果观察组PaO2、FVC、FEV1、IC值显著高于对照组(均P0.05),肺不张及肺部感染率显著低于对照组,住院时间显著短于对照组(P0.05,P0.01)。结论对肺癌行切除术患者,围术期采用呼吸训练器进行呼吸功能锻炼,较常规方法更有助于改善肺功能,降低不良事件发生率。     

围术期综合康复训练对促进老年肺癌患者术后恢复效果分析

目的探讨围术期综合康复训练对改善老年肺癌患者术后恢复的效果。方法回顾性分析内黄县中医院2018-02—2020-08行肺癌根治术的70例老年患者的临床资料。根据围术期康复训练方法分为常规康复训练组(常规组)和常规康复训练联合综合康复训练组(综合组),每组35例。比较2组患者术前及术后3个月时的第1s用力呼气容积(FEV1)、用力肺活量(FVC)和最大肺活量(MVV)肺功能指标。采用6 min步行试验(6MWT)测定运动功能。统计术后4周内肺部感染、肺不张,以及呼吸衰竭并发症发生率。结果综合组术后3个月时FEV1、MVV、FVC和6MWT均优于常规组,术后肺部并发症发生率低于常规组。差异均有统计学意义(P<0.05)。结论围术期加强呼吸、运动等综合训练,能够显著改善老年肺癌术后患者的肺功能和运动功能,降低术后肺部并发症发生风险。     

系统呼吸训练对肺癌患者术后肺功能的影响

目的探讨系统呼吸训练对肺癌患者术后肺功能的影响.方法将152例肺癌术后患者随机分为观察组(82例)和对照组(70例),对照组行常规胸部术后护理;观察组在此基础下行缩唇呼气训练及深呼吸训练6个月,并于术前、术后2周、3个月、6个月评估两组患者肺功能(FVC,FEV1,FEV1/FVC).结果两组术后不同时段肺功能均较术前下降(P<0.05,P<0.01).观察组术后3、6个月肺功能较术后2周显著改善(均P<0.05);与对照组同时段比较,差异有显著性意义(均P<0.05).而对照组仅FEV1在术后3、6个月有所改善,与术后2周比较,差异有显著性意义(均P<0.05).结论术后呼吸训练能够改善肺癌患者术后肺功能.     

术前呼吸功能训练改善肺癌术后患者呼吸功能的护理研究

目的研究呼吸功能训练对肺癌肺叶切除术患者术后呼吸功能及排痰的影响。方法选取我院2015年5月~2016年11月收治的80例接受肺叶切除术治疗的肺癌患者作为研究对象。将2015年5月至2016年2月期间接受常规护理的40例患者纳入对照组,手术前后接受健康宣教、吸氧、雾化吸入等常规护理;将2016年3月至2016年11月期间在常规护理基础上接受术前呼吸功能训练的40例患者纳入研究组。比较两组患者术前、术后7 d的呼吸功能包括每分钟最大通气量(MVV)、用力肺活量(FVC)、1秒用力呼气容积(FEV_1)、动脉血氧分压(PaO_2)、动脉二氧化碳分压(PaCO_2)、排痰量、术后住院时间、并发症发生率。结果术后两组患者MVV%、FVC%、FEV_1%、PaO_2水平均低术前,PaCO_2水平均高于术前,差异有统计学意义(P0.05);术后对照组MVV%、FVC%、FEV_1%、PaO_2水平低于研究组,差异有统计学意义(P0.05);两组患者术后PaCO_2水平比较,差异无统计学意义(P0.05);对照组患者术后排痰量低于研究组,术后住院时间高于研究组,差异有统计学意义(P0.05);术后对照组患者并发症总发生率高于研究组,差异有统计学意义(P0.05)。结论呼吸功能训练能降低肺叶切除术对肺癌患者术后呼吸功能的影响,改善呼吸功能,促进排痰,缩短术后住院时间,降低并发症发生风险,促进患者康复。     

周围型肺癌单孔胸腔镜与三孔胸腔镜肺叶切除术对机体炎性反应的影响

目的分析周围型肺癌单孔胸腔镜与三孔胸腔镜肺叶切除术对机体炎性反应的影响。方法根据不同胸腔镜戳孔将82例周围型肺癌患者分为2组,各41例。观察组行单孔胸腔镜肺叶切除术,对照组行三孔胸腔镜肺叶切除术。结果 2组术中出血量、淋巴结清扫数差异无统计学意义(P0.05)。观察组手术时间长于对照组,术后引流管留置时间、住院时间少于对照组,术后第3天的血清炎症因子升高幅度低于对照组,并发症总发生率低于对照组。差异均有统计学意义(P0.05)。结论单孔胸腔镜肺叶切除术炎症反应轻,并发症少,有利于患者术后恢复。     

肺切除手术对肺癌患者右心功能的影响分析

目的探讨不同肺切除手术对肺癌患者右心功能的影响。方法随机将67例肺癌患者分为全肺切除术组(31例)和肺叶切除术组(36例),观察比较2组患者术前及术后第8天的右心功能各项指标的变化情况。结果术后第8天,肺叶切除组患者Pa O2、RVEF均明显高于全肺切除术组患者,而HR、RVEDVI、m PAP均低于全肺切除术组患者,组间比较差异有统计学意义(P0.01)。结论与全肺切除术相比,肺叶切除术对肺癌患者右心功能的影响较小,近期效果好。     

肺移植供肺保护进展

肺移植成为终末期肺病的惟一治疗手段。然而其死亡率仍高于其他实质器官移植,供肺保存过程中损伤机制的探讨与保存方法的改进将有利于提高生存率。     

Effect of Bovine Pericardial Strips on Air Leak After Stapled Pulmonary Resection

Background. Surgical procedures for emphysema have been proposed and in many settings resulted in significant improvement in dyspnea and function. The most prevalent surgical problem in all series is prolonged postoperative air leak.

Methods. One hundred twenty-three patients undergoing stapled thoracoscopic unilateral lung volume reduction operation were prospectively randomized to receive either no buttressing of their staple lines or buttressing of all staple lines with bovine pericardial strips.

Results. The two groups were comparable in preoperative risks and in the severity of their emphysema. Postoperative complications were identical in the two groups with respect to pneumonia, empyema, and wound infection; however, there was a significant difference in the duration of postoperative air leaks. Those having the pericardial strips used to buttress their staple lines had chest tubes removed 2.5 days sooner and were discharged from the hospital 2.8 days sooner as a result. The cost data revealed that because of the cost of the pericardial sleeves, the overall hospital charges were almost identical for the two groups ($22,108 bovine, $22,060 no bovine) in spite of the shortened hospital stay.

Conclusions. The use of bovine pericardial sleeves to buttress the staple lines in thoracoscopic unilateral lung volume reduction operation results in a shorter duration of postoperative air leaks. Total hospital charges were comparable in the two groups as the 2.8 days saved in the hospital were offset by the cost of the pericardial sleeves.     

Coexistence of lung cancer and hamartoma

We present a rare case of a synchronous primary lung cancer adjacent to a hamartoma. A 71-year-old woman was admitted with congestive heart failure due to acute myocardial infarction. A chest radiogram on admission showed pulmonary edema with a tumor shadow in the right upper lung field. Because histological diagnosis was not obtained preoperatively, a wedge resection of the lung was conducted using video-assisted thoracoscopic surgery. The histopathological examination confirmed the coexistence of an adenocarcinoma with a chondromatous hamartoma. Right upper lobectomy was performed followed by excision of the mediastinal lymph nodes. Although hamartoma is generally considered to be a benign neoplasm, there have been several reports of increased risk to lung cancer in patients with a chondromatous hamartoma. Therefore, we recommend that patients with a hamartoma should be submitted to a complete evaluation and to regular follow-up, considering the risk to associated synchronous malignancy.     

Total and prolonged filling of the lungs with Ringer's solution under extracorporeal lung assist (ECLA) in dogs

BACKGROUND: Massive alveolar lavage has been used clinically to remove materials accumulated in the alveoli. Recently, filling the lungs with oxygenated perfluorochemical (total liquid ventilation) has been investigated. However, effects of complete and prolonged filling of bilateral lungs with aqueous fluid, such as saline or Ringer's solution, has not been evaluated, although it is possible to sustain gas exchange without the natural lung by using extracorporeal circulation and an artificial lung (extracorporeal lung assist: ECLA). It is also not known whether the lung can recover gas exchange ability after prolonged fluid filling. METHODS: Normal mongrel dogs were endotracheally intubated under general anesthesia and mechanically ventilated. After initiation of venoarterial ECLA, warmed lactated Ringer's solution was instilled into the lungs through the endotracheal tube, and the lungs were completely filled at a hydrostatic pressure of 15 cmH2O (fluid-filled group: group F). After the lungs were filled for 4 h, the fluid was drained and ventilation was re-instituted. ECLA, then mechanical ventilation was gradually weaned within 24 h after fluid drainage. In control group (group C), dogs were kept apneic for 4 h with their lungs inflated at an airway pressure of 15 cmH2O with air. RESULTS: Transient hypoxemia occurred during fluid filling but every dog could be weaned from ECLA and mechanical ventilation to spontaneous respiration. The average rate of fluid absorption from the lung during fluid filling was 4.2+/-1.8 ml kg(-1) h(-1). After fluid drainage and restart of mechanical ventilation, bilateral lungs were expanded and well aerated. Total static respiratory system compliance (static compliance) remained unchanged even after fluid filling, and the weight of the lung water did not increase significantly compared to that in group C. Total urine volume was significantly increased in group E Histologically, alveolar structures were preserved and no interstitial edema or bleeding was seen in either group. CONCLUSION: Complete filling of the bilateral lungs for 4 h with lactated Ringer's solution under ECLA causes no deterioration in gas exchange or static compliance in normal dogs, although transient hypoxemia occurs during fluid filling.     

Pulmonary Resection for Lung Trauma

Background. Pulmonary resection is rarely required for trauma, and its mortality is reportedly high.

Methods. A 10-year retrospective review of pulmonary resections for trauma was done.

Results. Of 2,455 patients with chest trauma, 183 (7.4%) underwent thoracotomy and 32 (1.3%) required pulmonary resection. Mean age was 28.4 years and mean injury severity score was 24.5. Mechanism of injury was stab wound in 14 patients, gunshot wound in 6, and blunt trauma in 12. Blunt trauma patients had a higher injury severity score (29.6) than penetrating trauma patients (21.4), but this was not significant (p < 0.07). Indications for thoracotomy were hemorrhage in 24 patients, airway disruption in 4, and other indications in 4. Operations consisted of wedge resection (19 patients), lobectomy (9), and pneumonectomy (4). Four (12.5%) patients (pneumonectomy, 2; lobectomy, 1; wedge, 1) died. Mortality for pneumonectomy was 50%, but this was not significantly higher than for lesser resections. Blunt trauma had a higher mortality (33%) than penetrating trauma (0%) (p < 0.02). Nonsurvivors had higher injury severity scores (44.2) than survivors (21.6) (p < 0.001).

Conclusions. Pulmonary resection is infrequently required for lung injury. Overall mortality is lower than previously reported, but pneumonectomy has a high mortality. Blunt trauma has a higher mortality than penetrating trauma. Injury severity scores are higher for nonsurvivors than survivors; this shows the importance of associated injuries on outcome.     

Heterotopic lung transplant: a feasible approach to compensate for organ shortages

Lung transplants are still limited by the shortage of suitable donor lungs, especially during the coronavirus disease 2019 pandemic. A heterotopic lung transplant (HLTx), as a flexible surgical procedure, can maximize the potential of donor lungs in an emergency, but its widespread use is hindered by difficulties in anastomosis and paucity of outcome data. We performed a retrospective review of 4 patients, each of whom received an HLTxs over 1 year, including 1 left-to-right single HLTx, 2 right-to-left single HLTxs and 1 lobar HLTx (right upper lobe-to-left). The median recipient age was 58.5 years (46–68); 3 patients were male. The postoperative hospital stay was 33 days (30–42). One recipient lived for 10 years and died of bronchiolitis obliterans syndrome; the others were alive with no major morbidity at 12 to 31 months after the operation with a 1-year survival of 100%. The follow-up chest images showed that transplanted lungs could be inflated well and adapted morphologically to fill the thoracic cavity in the short and long term. This study demonstrates that an HLTx is a feasible alternative to a conventional lung transplant in emergency cases and could be considered in selected patients at advanced medical centres.     

Initial In Vitro Evaluation of a Pediatric Vortex-Mixing Membrane Lung

Abstract: A new design for a pediatric membrane lung is described in this paper. The lung consists of eight blood compartments, each having six U-shaped blood channels, with microporous PTFE membranes supported on rigid plates in such a way that the membranes form furrowed blood channels. Two rolling diaphragm pumps are attached to the open ends of the U-shaped blood channels; these pumps are operated in antiphase. Mean flow is provided by a roller pump placed at the inlet end of the membrane lung. Pulsatile blood flow within the blood channels produces successive vortex formation and ejection, leading to good blood mixing and high efficiency in gas transport. The design of the rolling diaphragm piston pumps ensures that the blood prime volume is low (280 ml), and the grouping of the pumps at one end of the oxygenator allows the driving mechanism to be simple and compact. The relatively wide blood channels (minimum width 0.5 mm) and vortex mixing make priming the membrane lung particularly easy. The membrane area is 0.39 m². Preliminary performance testing of the pediatric membrane lung was undertaken by pumping blood around a circuit containing a roller pump, the membrane lung, and a bubble oxygenator (to adjust the blood gases at the inlet to the membrane lung). In five such experiments it was shown that the membrane lung transferred 80 ml O₂/min and 120 ml CO₂/min at a blood flow rate of 1.5 L/min.