论文部分内容阅读
目的探讨同侧肺叶切除手术后由于各种原因可能对同侧余肺再次手术切除完成不同期全肺切除与一次性完成全肺切除的临床特点。方法分析本院40年来各种原因以同侧余肺切除完成不同时期全肺切除的患者36例(距第一次肺手术时间1～420个月)。结果全部患者均完成同侧余肺切除,手术后病理检查为余肺结核(31%,11/36),余肺癌(31%,11/36),余肺支气管扩张症(8%,3/36),多发性肺囊肿(8%,3/36),余肺感染、脓肿、坏死等(22%,8/36)。余肺切除后主要并发症有手术后胸腔感染(22%,8/36),支气管胸膜瘘(14%,5/36),严重心血管并发症并导致围手术期死亡(8%,3/36,分别为急性心肌梗死、肺动脉栓塞、恶性心律失常各1例)。结论同侧余肺切除完成不同期全肺切除的主要手术适应证是:①肺结核、肺癌复发;②支气管扩张症残留症状;③治疗肺叶切除术后余肺严重并发症。手术中出血较一般全肺切除多,术后主要并发症是胸腔内感染、支气管胸膜瘘及循环系统并发症。严格手术指征、了解第一次肺手术的全过程、提高手术技巧减少手术中出血、严谨的围手术期处理是余肺切除术取得成功的关键因素,对于同侧余肺切除完成不同期全肺切除如果手术适应证正确,围手术期处理得当,其临床结果是令人满意的。
Objective To investigate the clinical features of resection of pneumonectomy at one time and complete resection of pneumonectomy at the same time after ipsilateral lobectomy for various reasons. Methods Thirty-six patients (ranging from 1 to 420 months after the first pulmonary surgery) who underwent pneumonectomy at different stages of ipsilateral pulmonary resection for various reasons in our hospital for 40 years were analyzed. Results All the patients underwent resection of ipsilateral lungs. The postoperative pathologic findings were: extra pulmonary tuberculosis (31%, 11/36), extra lung cancer (31%, 11/36), residual lung bronchiectasis (8%, 3/36 ), Multiple pulmonary cysts (8%, 3/36), excess lung infections, abscesses and necrosis (22%, 8/36). The main complications after pneumonectomy were postoperative thoracic infection (22%, 8/36), bronchopleural fistula (14%, 5/36), severe cardiovascular complications and perioperative death (8%, 3 / 36, respectively, acute myocardial infarction, pulmonary embolism, malignant arrhythmia in 1 case). Conclusion The main indications for performing pneumonectomy in different stages of ipsilateral pneumonectomy are: tuberculosis, recurrent lung cancer; residual symptoms of bronchiectasis; and severe complications of remaining lung after lobectomy. Bleeding surgery than the general pneumonectomy and more, the main complication after surgery is intrathoracic infection, bronchopleural fistula and circulatory complications. Strict surgical indications, to understand the whole process of the first pulmonary surgery, improve surgical skills to reduce bleeding during surgery, rigorous perioperative management is the key to successful lung harvesting, the same side of the completion of different stages of lung resection Lung resection If the indications for surgery, perioperative management properly, the clinical results are satisfactory.