肺癌全肺切除术后常见并发症临床分析

目的总结肺癌全肺切除术术后常见并发症,分析其预防及处理方法。方法回顾性分析我科2009年1月至2011年10月施行全肺切除手术的155例肺癌患者的临床资料,统计患者年龄、术前夹杂病史、肺功能、术后带管时间及术后住院时间等指标。结果 51例术后发生各类并发症,占32.90%,其中心律失常31例,肺部感染13例,急性呼吸衰竭1例,肺栓塞3例,支气管胸膜瘘2例,术后胸腔内活动性出血1例。全组围术期死亡5例,手术死亡率3.23%,其中3例考虑为肺栓塞引起死亡,其余2例为术后肺部感染导致呼吸衰竭死亡。结论肺癌全肺切除是一种高风险术式,心律失常、肺部感染、急性呼吸衰竭、支气管胸膜瘘及肺栓塞是术后常见的并发症。对拟行全肺切除的患者,要严格掌握手术适应证,术前检查应更加全面准确;术后加强围术期管理,严密监护,做到及时、正确的处理。

Common complications after pneumonectomy for lung cancer:an analysis of 155 cases

Objective To summarize the common complications following pneumonectomy due to lung cancer,and investigate how to prevent and manage them.Methods A total of 155 patients of lung cancer undergoing pneumonectomy in our department during the time period of January 2009 to October 2011 were enrolled in this study.A retrospective analysis of their clinical data was conducted,including age,preoperative medical history,lung function,postoperative intubation time and postoperative hospital stay.Results Complications occurred in 51 cases,accounting for 32.90%.These were arrhythmia in 31 cases,lung infection in 13 cases,acute respiratory failure in 1 case,pulmonary embolism in 3 cases,bronchopleural fistula in 2 cases,and postoperative intrathoracic active bleeding in 1 case.Five patients died in peri-operative time,and the surgical mortality was 3.22%.The causes of death were probably pulmonary embolism for 3 cases,and respiratory failure following postoperative pulmonary infections in the other 2 cases.Conclusion Pneumonectomy for lung cancer patients is a high-risk surgical procedure,and postoperative common complications include arrhythmia,lung infection,acute respiratory failure,pulmonary embolism and bronchopleural fistula.Surgical indications should be strictly defined for the patients who are about to take pneumonectomy.Before operation,comprehensive and accurate examinations are necessary.After operation,perioperative management and intensive care should be enhanced so as to reduce the incidence of complications and hazards following pneumonectomy by means of timely and correct treatment.