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目的探讨单侧肺循环短暂阻断术(同期阻断肺动脉、肺静脉)治疗累及肺血管的局部晚期非小细胞肺癌(NSCLC)的应用价值。方法30例侵犯肺动脉的局部晚期NSCLC,开胸后探查见肺动脉干受侵,在心包内或心包外游离出患侧肺动脉干根部和上、下肺静脉,放置血管阻断钳同时阻断三支血管以防止肺动脉和左心房血液逆行倒灌出血。在患侧肺循环无血状态下切除病肺和受肺癌侵犯的部分肺动脉。行肺动脉成形或吻合后,开放阻断的肺动脉干和保留肺静脉,恢复其肺循环。20头杂种猪随机分成单侧肺循环阻断组和单纯肺动脉阻断组(每组各10头),分别阻断单侧肺循环或单纯肺动脉60min,再灌注240min后,取肺组织进行光镜、电镜检测缺血再灌注损伤情况,然后饲养7d,再次获取的肺组织进行光镜、电镜检测缺血再灌注损伤情况。结果30例侵犯肺动脉的局部晚期NSCLC切除率为100%,均保留了健康有功能的上叶肺或下叶肺,避免了全肺切除。肺动脉、肺静脉阻断的时间分别为(48±7.5)min(18～72min)和(33±6.8)min(16～66min)。术中平均出血量(248±34)ml(172～412ml),5例双袖切的患者术后因痰阻塞支气管引起肺不张,其中1例出现心律失常,经对症处理后好转。动物实验的结果提示:单纯肺动脉阻断组和单侧肺循环阻断组两种术式均使保留肺产生缺血再灌注损伤;肺血管阻断至少在一定时限内(本组为60min)保留肺产生缺血再灌注损伤是可逆的(本组为术后7d)。结论单侧肺循环阻断术为不能耐受全肺切除的局部晚期NSCLC患者保留健康肺,提供了一种安全、简捷的新手术方法。
Objective To investigate the value of transient occlusion of unilateral pulmonary circulation (blocking the pulmonary artery and pulmonary vein during the same period) in the treatment of locally advanced non-small cell lung cancer (NSCLC) involving the pulmonary vessels. Methods Thirty patients with locally advanced NSCLC invading the pulmonary artery were enrolled. Thoracotomy was performed to investigate the invasion of the pulmonary artery. The peritoneal or pericardial out of the pericardium and the superior and inferior pulmonary veins were separated from the pericardium and pericardium. The vascular occlusion forceps were placed while the three vessels were blocked To prevent retrograde flow of blood in the pulmonary artery and left atrium. In the ipsilateral pulmonary circulation without excision of diseased lung disease and lung cancer invaded by part of the pulmonary artery. After pulmonary artery formation or anastomosis, open the blocked pulmonary artery and retain the pulmonary veins to restore the pulmonary circulation. Twenty hybrid pigs were randomly divided into unilateral pulmonary circulation block group and simple pulmonary artery block group (10 in each group), blocking unilateral pulmonary circulation or pulmonary artery 60min respectively. After 240min reperfusion, the lung tissue was taken out for light microscope and electron microscope The ischemia-reperfusion injury was detected. After 7 days of rearing, the re-obtained lung tissue was subjected to light and electron microscopy to detect the injury of ischemia-reperfusion. Results Thirty patients with locally advanced NSCLC who had infiltrated the pulmonary artery had a resection rate of 100%. All of them retained healthy and superior upper or lower lobes, and avoided pneumonectomy. Pulmonary artery and pulmonary vein occlusion time were (48 ± 7.5) min (18 ~ 72min) and (33 ± 6.8) min (16 ~ 66min) respectively. The mean intraoperative blood loss was (248 ± 34) ml (172-412 ml). Five patients with double-sleeved patients suffered from atelectasis due to obstruction of the bronchi after sputum operation. One patient had arrhythmia and was symptomatically cured. The results of animal experiments suggest that both the simple pulmonary artery occlusion group and the unilateral pulmonary circulation occlusion group both retain the lung ischemia-reperfusion injury; pulmonary vascular occlusion at least within a certain period of time (this group is 60min) to retain the lung The resulting ischemia-reperfusion injury is reversible (this group is 7 days after surgery). Conclusions Unilateral pulmonary circulation occlusion provides a safe and simple new surgical method for the maintenance of healthy lungs in patients with locally advanced NSCLC who can not tolerate pneumonectomy.