经心包内全肺切除治疗中晚期中央型肺癌临床分析.doc

1 经心包内全肺切除治疗中晚期中央型肺癌临床分析作者: 毕磊,吕帆真,沈晓咏,倪国兴【摘要】目的探讨经心包内处理肺血管全肺切除术的手术操作、术后呼吸、血气及心功能的变化。方法回顾性分析 42 例经心包内全肺切除术患者的临床资料。结果 42例患者术中无一例因心包切开引起不可逆性心律失常, 术后并发呼吸衰竭及术后死亡均与切开心包无明显关系。结论经心包内处理肺血管全肺切除术安全性较好, 可提高肺癌切除率、延长术后生存期。【关键词】肺癌;心包;全肺切除术 Clinical analysis of intrapericardial total pneumonectomy of central lung cancer at intermediate or advanced stage 【 Abstract 】 Objective To explore the surgical procedure , postoperative respiration , blood gas analysis and heart function changes relevant to intrapericardial total 2 To review and analyze the clinical data of 42 cases of the intrapericardial total No case of nonreversible arrhythmia was caused by we found there was no obvious relationship between pericardiotomy and postoperative failure of respiration and postoperative Intrapericardial total pneumonectomy is safe , it can raise the pulmonary resection rate and prolong the survival period of the patients. 【 Key words 】 lung cancer ; pericardium ; total pneumonectomy 近年来随着肺癌发病率逐年增加, 临床上Ⅲ期中央型肺癌增多[1], 手术治疗适应证相应扩大, 方式增多, 难度也增大。本文总结我院胸外科自 1995 ~ 2003 年局部晚期肺癌因肺门冻结必须切开心包后施行全肺切除 42 例患者的手术操作、术后呼吸、血气及心功能的变化。 1 临床资料 一般资料本组患者 42 例,其中男 36 例,女 6例,年 3 龄 34~ 72 岁,平均 58 岁, 60 岁以上 30 例。鳞癌 31例,腺癌8例, 腺鳞癌 2例, 小细胞癌 1例。肿瘤紧靠肺门生长 29 例, 肺门或纵隔淋巴结广泛转移致“肺门冻结” 10例, 肿瘤累及部分心包 3 例。 术前肺功能(1) 肺活量占预计值< 60% 者4例, 61% ~ 70% 者5例, 71% ~ 80% 者9例