Completion pneumonectomy:: Current indications, complications, and results
Completion pneumonectomy:: Current indications, complications, and results
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DOI：
10.1067/mtc.2001.112471
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发表时间：
2001-03-01
影响因子：
6
通讯作者：
Stamatis, G
中科院分区：
文献类型：
--
作者：
Fujimoto, T;Zaboura, G;Stamatis, G
目的：据报道，全肺切除术的发病率和死亡率较高，尤其是在良性疾病患者中;我们回顾了9年的经验，以评估各种适应症的术后结果和长期结果。方法：1990年1月至1998年12月期间，连续66例患者接受了完全肺切除术（占所有肺切除术的6.8%），并对他们的病例进行了回顾性分析。适应症为良性疾病17例，恶性疾病49例。恶性肿瘤患者中，局部复发14例，第二原发肿瘤4例，转移瘤5例，初次手术切除不完全者26例。32例（53%）患者出现并发症，良性适应症（71%）和恶性适应症（47%; P = 0.0923）之间无任何显著差异。支气管胸膜瘘5例（7.6%），脓胸7例（11%）。所有患者的5年生存率为57%，良性指征患者为65%，恶性指征患者为54（60%为局部复发，50%为第二原发肿瘤，56%为不完全切除），良性和恶性适应症之间无任何差异结论：全肺切除术的死亡率和并发症是可以接受的，即使是良性疾病患者。术前感染的患者可以通过支气管残端覆盖和充分的术后引流来管理。虽然并发症很常见，但只要正确理解它们，就可以成功地进行管理。
Objective: Completion pneumonectomy is reported to be associated with high morbidity and mortality, especially when done in patients with benign disease; We review our 9 years of experience with this operation to evaluate the postoperative outcome and long-term results of various indications.Methods: Between January 1990 and December 1998, 66 consecutive patients underwent completion pneumonectomy (6.8% of all pneumonectomies), and their cases were retrospectively reviewed. The indication was benign disease in 17 patients and malignant disease in 49 patients. In patients with malignant indications there were 14 local recurrences, 4 second primary tumors, 5 metastatic diseases, and 26 indications because of incomplete initial resection.Results: There were no intraoperative deaths, and the postoperative mortality rate was 7.6%. Complications were encountered in 32 (53%) patients, without any significant difference between benign indication (71%) and malignant indication (47%; P = .0923). Bronchopleural fistula was encountered in 5 (7.6%) patients, and empyema was encountered in 7 (11%) patients. The actuarial 5-year survival was 57% for all patients, 65% for those with benign indications, and 54% for those with malignant indications (60% for local recurrence, 50% for second primary tumor, and 56% for incomplete resection), without any difference between benign and malignant indications (P = .9478).Conclusions: Completion pneumonectomy can be performed with acceptable mortality and morbidity, even in patients with benign disease. Patients with preoperative infection can be managed with bronchial stump covering and adequate postoperative drainage. Although complications are common, they can successfully be managed with a proper understanding of them.