EARLY AND LONG-TERM RESULTS AFTER COMPLETION PNEUMONECTOMY
EARLY AND LONG-TERM RESULTS AFTER COMPLETION PNEUMONECTOMY
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DOI：
10.1016/0003-4975(94)00728-p
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发表时间：
1995-01-01
影响因子：
4.6
通讯作者：
MORAND, G
中科院分区：
文献类型：
--
作者：
MASSARD, G;LYONS, G;MORAND, G
从1978年1月1日至1992年12月31日，37例患者在既往肺叶切除术后接受了全肺切除术（36例男性和1例女性;平均年龄60岁;范围41至77岁）。这些占758例肺切除术的4.8%。本研究的目的是评估全肺切除术的手术效果和长期生存的支气管肺癌患者。原发性支气管肺癌23例，转移性甲状腺腺癌1例，良性疾病13例（结核11例，曲菌球1例，支气管扩张1例）。32例（I期15例，II期6例，III期11例）支气管肺癌行全肺切除术。1例患者复发转移性甲状腺癌，2例支气管扩张，2例肺叶切除术后静脉梗死。4例患者（10.8%）围手术期死亡，原因如下：1例术中出血致死，1例术后出血致死，1例尿毒症和1例恶性高钙血症。中位手术失血量为1，000 mL，19例患者出血超过1，000 mL（51%）。6例患者术中血管损伤。9例患者（24%）发生了非致死性手术并发症，包括5例血栓性血胸、3例脓胸和1例支气管胸膜瘘。4例患者出现内科并发症（2例肺水肿、1例窦性心动过速和1例不明原因发热）。23例患者顺利恢复（62%）。32例支气管肺癌患者随访至死亡或1993年7月1日。总体5年生存率为44.5%（I期59.7%，II期41.6%，III期21.2%）。我们的结论是，有一个完整的肺切除术后手术风险增加，但是，这种风险是可以接受的长期生存。
From January 1, 1978 to December 31, 1992, 37 patients underwent a completion pneumonectomy after a previous lobectomy (36 men and 1 woman; mean age, 60 years; range, 41 to 77 years). These account for 4.8% of 758 pneumonectomies. The purpose of the present study was to evaluate the operative results of completion pneumonectomy and long-term survival in patients with bronchogenic cancer. The initial lung resection had been performed for primary bronchogenic cancer in 23, metastatic thyroid adenocarcinoma in 1, and benign diseases in 13 (tuberculosis in 11, aspergilloma in I, and bronchiectasis in 1). Completion pneumonectomy was required for bronchogenic cancer in 32 (15 stage I, 6 stage II, 11 stage III). One patient had relapsing metastatic thyroid carcinoma, 2 had bronchiectasis, and 2 had a venous infarction after lobectomy. Four patients (10.8%) died perioperatively of the following causes: 1 fatal intraoperative bleeding, 1 fatal postoperative bleeding, 1 pneu-monia, and 1 malignant hypercalcemia. Median operative blood loss was 1,000 mL, and 19 patients experienced bleeding exceeding 1,000 mt (51%). Six patients had intraoperative vascular injury. Nonfatal surgical complications occurred in 9 patients (24%), including 5 clotted hemothoraces, 3 empyemas, and 1 bronchopleural fistula. Four patients had medical complications (2 pulmonary edemas, 1 sinus tachycardia, and 1 unexplained fever). Twenty-three had an uneventful straightfoward recovery (62%). The 32 patients with bronchogenic cancer were followed up until date of death or July 1, 1993. Overall 5-year survival was 44.5% (59.7% for stage I, 41.6% for stage II, and 21.2% for stage III). We conclude that there is an increased operative risk after completion pneumonectomy; however, this risk is acceptable with respect to long-term survival.