肺癌合并慢性阻塞性肺疾病(COPD)患者围手术期优化管理的研究进展

慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)是肺癌的常见合并症。肺癌患者合并COPD不仅会降低或推迟手术机会,而且会增加术后并发症并促进术后肿瘤复发转移,严重损害肺癌患者的预后和生存。围手术期间优化对COPD的管理是肺癌合并COPD患者进行手术治疗时的必然要求。以吸入支气管扩张剂、联合吸入糖皮质激素为主的COPD管理措施联合肺康复训练能提高肺癌合并COPD患者的手术机会或减少术后并发症。加上明显提高患者心肺耐力的肺康复训练,在完善术前风险评估、优化手术方式和技术并辅以其他有利因素的情况下,将会有更多的肺癌合并COPD患者能够安全地接受手术并获得良好的术后效果。呼吸科医师应积极应对当前肺癌合并COPD在诊断和治疗方面的问题,与胸外、康复和麻醉等多学科团队合作,共同优化肺癌合并COPD患者的围手术期管理。

Research progress of optimal perioperative management for patients with lung cancer and chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a common comorbidity of lung cancer. Comorbidity of COPD not only decreases or delays lung cancer operation,but also promotes postoperative complications and cancer recurrence or metastasis, which seriously impairs prognosis and survival of lung caner patients.So it is imperative to optimize the perioperative management of COPD. Enhanced COPD management with inhaled bronchodilators and/or combination with inhaled corticosteroids would increase operation chance or decrease postoperative complications of lung cancer patients with COPD. Together pulmonary rehabilitation, adequate preoperative risk assessment, optimal surgical approach and technique as well as other favorable factors would help lung cancer patients with COPD to go through lung cancer surgery in security and achieve a satisfactory postoperative curative effect. Pulmonologist should be responsible for the current challenges of diagnosis and treatment of COPD comorbidity and involve in the multi-disciplinary team with thoracic surgeons, rehabilitation therapists and anesthesiologists to achieve an optimal perioperative management for lung cancer patients with COPD.