全肺切除手术分析

目的：探讨全肺切除术的病因及并发症。方法：分析199例全肺切除术的围手术期处理。结果：199例全肺切除术中，支气管残端均采用纵隔胸膜包埋；其中因肺肿瘤而实施全肺切除的189例，占95％（189／199）；心包内处理肺血管行全肺切除者27例，占13．6％（27／199）；术后30d内发生各类并发症35例，占17．6％（35／199）；其中心率失常20例，占10．1％（20／199），支气管胸膜瘘2例，占1％（2／199），死亡2例，死亡率1％（2／199）。结论：全肺切除的主要病因为肺部肿瘤；心包内全肺切除可提高病肺的手术切除率；史气管残端纵隔胸膜化能降低支气管胸膜瘘的发生；术后严格限制晶体补液量，滴注白蛋白等胶体液，利尿，减轻肺水肿，是防止心律失常及心功能不全的有效方法。

THE ANALYSIS OF 199 PATIENTS WITH PNEUMONECTOMY

Objective:To discuss the etiology of pneumonectomy and the treatment of the complications.Methods:To analyse the treatment in the perioperative period of 199 patients with pneumonectomy.Results:Among 199 cases of pneumonectomy,189 cases were caused by lung tumors(95%,189/199);27 cases were carried on intrapericardial pneumonectomy with the treatment of lung vessels(13.6%,27/199);the stumps of bronchi were all embedded with mediastinal pleura.Kinds of postsurgical complications occurred in 35 cases(17.6%,35/199):20 cases with arrhythmia(10.1%,20/199);2 cases with bronchopleural fistula(1%,2/199);2 cases died,with the mortality of 1%(2/199).Conclusion:The main causes of pneumonectomy are lung tumors,and intrapericardial pneumonectomy could raise the ratio of the removal with the suffered lungs.The way of covering the stumps of bronchi with mediastinal pleura could reduce the incidence of bronchopleural fistula.The effective ways to prevent postoperative arrhythmia and cardiac insufficiency are to restrain the infusion of crystal,drip with colloid such as albumin,increase the flow of urine and relieve the pulmonary edema.