余肺切除术治疗复发性肺癌32例分析

目的　探讨余肺切除术治疗复发性肺癌的疗效、围术期风险因素及处理方法。方法　复习 32例此类病例 ,采用生命表法计算 1、2、5年生存率。并将本组病例按某项并发症是否发生分组 ,以t检验比较各组间各项因素差异是否有显著性。结果　 17例经心包内处理血管 ;8例经胸膜外剥离径路。术中失血 40 0～ 870 0ml(平均 15 16ml )。术后心血管系并发症 12例 (循环不稳定 3例、心律不齐 9例 ) ,支气管胸膜瘘 4例 ,应激性溃疡 2例。再手术后 1、2、5年生存率分别为 88 89%、72 80 %、18 45 %。与术后并发症发生相关的因素为年龄、手术时间、余肺切除术前MVV值、余肺手术前有气急或心电图表现异常与否等。结论　对复发性肺癌的再手术治疗应持积极态度。

Completion pneumonectomy for recurrent lung cancer (Report of 32 cases)

Objective: To study the prognosis, complication related risk factors and corresponding strategies of completion pneumonectomy for recurrent lung cancer. Methods: Thirty-two patients with recurrent lung cancer underwent completion pneumonectomy. The 1,2,5-year survival rates were calculated by means of life table. T-mean comparison was executed to select the prominent risk factors due to different complication groups. Results: There were 17 cases of intrapericardial ligation of the pulmonary vessels, and 8 cases of extrapleural dissection. Blood loss during the operation was 400 to 8700 ml (averaging 1516 ml). Postoperative cardiovascular complications were seen in 12 cases (3 hypotension, 9 arrhythmia), bronchopleural fistula and stress related gastric ulcer was seen in 4 and 2 cases, respectively. The 1,2,5-year survival rates were 88.89%,72.80% and 18.45%. The risk factors for complications were age, operation time, preoperative MVV, and the existing shortness of breath or ECG abnormalities. Conclusions: Completion pneumonectomy is a relatively safe and effective method for recurrent lung cancer. Thoracic surgeons should assume an aggressive attitude toward completion pneumonectomy for recurrent lung cancer.