全胸腔镜肺叶切除对腹型肥胖低肺功能肺癌患者术后心肺功能的影响
전흉강경폐협절제대복형비반저폐공능폐암환자술후심폐공능적영향
Effects of Complete Video-assisted Thoracoscopic Lobotomy on Heart and Lung Functions in Abdominal Obesity Patients with Lower Lung Function Lung Cancer
  • 万方数据
    中国微创外科杂志 중국미창외과잡지
    Chinese Journal of Minimally Invasive Surgery
    2015年 10期 917-921 ,共5页

    张六伢%李远静%陈维%孟小鹏

    장륙아%리원정%진유%맹소붕

    腹型肥胖%肺癌%全胸腔镜%肺叶切除%低肺功能 腹型肥胖%肺癌%全胸腔鏡%肺葉切除%低肺功能
    복형비반%폐암%전흉강경%폐협절제%저폐공능
    Abdominal obesity%Lung cancer%Complete video-assisted thoracoscopy%Lobotomy%Lower lung function
    目的：探讨全胸腔镜肺叶切除对腹型肥胖低肺功能肺癌患者术后心肺功能的影响。方法2013年7月～2014年6月对23例腹型肥胖伴低肺功能肺癌行全胸腔镜肺叶切除术，观察术后1周内心肺并发症，术前2 d，术后第3、7天，1．5、3、6个月行肺功能检查及登楼试验，评价心肺功能。结果术后心肺并发症发生率39．1％（9／23）。术后第3天较术前FVC[（1．83±0．45）L vs．（2．70±0．68）L，q ＝7．936，P ＜0．05]、FEV 1．0[（1．05±0．29）L vs．（1．75±0．25）L，q ＝9．745，P ＜0．05]、FEV 1．0／FVC[（53．3±7．6）％ vs．（70．2±6．0）％，q ＝9．902，P ＜0．05]、MVV[（55．3±14．9）L ／min vs．（86．8±16．5） L ／min，q ＝9．279，P ＜0．05]、FRC[（1．50±0．27）L vs．（2．25±0．35）L，q ＝8．920，P ＜0．05]明显下降，术后第7天较术前FVC[（2．07±0．53）L vs．（2．70±0．68）L，q ＝5．747，P ＜0．05]、FEV 1．0[（1．35±0．31）L vs．（1．75±0．25）L，q ＝5．568，P ＜0．05]、FEV 1．0／FVC[（57．6±7．4）％ vs．（70．2±6．0）％，q ＝7．382，P ＜0．05]、MVV[（66．3±15．8）L ／min vs．（86．8±16．5） L ／min，q ＝6．038，P ＜0．05]、FRC[（1．68±0．35）L vs．（2．25±0．35）L，q ＝6．779，P ＜0．05]下降明显；术后第7天与第3天比较，FEV 1．0[（1．35±0．31）L vs．（1．05±0．29）L，q ＝4．176，P ＜0．05]、MVV [（66．3±15．8）L ／min vs．（55．3±14．9） L ／min，q ＝3．240，P ＜0．05]有统计学差异，在短期内恢复；术后1．5月较术后第3、7天 FVC、FEV 1．0／FVC、MVV 明显好转（P ＜0．05），与术后3、6个月无统计学差异（P ＞0．05），肺功能趋于稳定；FVC、FEV 1．0、FEV 1．0／FVC、MVV 术后6个月与术前比较无统计学差异（P ＞0．05），表明肺功能已恢复到术前水平。登楼试验显示术后第7天仅2例（8．7％）能坚持到5楼，且 HR 明显升高、登楼时间延长及 SpO2下降均≥5％；术后1．5月登楼成功例数与术前无差异（P ＞0．05），术后3个月仅登楼时间较术前有明显差异（P ＜0．05）。结论腹型肥胖低肺功能肺癌患者行全胸腔镜肺叶切除术后1周对心肺功能影响明显，注意加强围手术期管理，1．5月后心肺功能逐渐代偿，恢复满意。
    목적：탐토전흉강경폐협절제대복형비반저폐공능폐암환자술후심폐공능적영향。방법2013년7월～2014년6월대23례복형비반반저폐공능폐암행전흉강경폐협절제술，관찰술후1주내심폐병발증，술전2 d，술후제3、7천，1．5、3、6개월행폐공능검사급등루시험，평개심폐공능。결과술후심폐병발증발생솔39．1％（9／23）。술후제3천교술전FVC[（1．83±0．45）L vs．（2．70±0．68）L，q ＝7．936，P ＜0．05]、FEV 1．0[（1．05±0．29）L vs．（1．75±0．25）L，q ＝9．745，P ＜0．05]、FEV 1．0／FVC[（53．3±7．6）％ vs．（70．2±6．0）％，q ＝9．902，P ＜0．05]、MVV[（55．3±14．9）L ／min vs．（86．8±16．5） L ／min，q ＝9．279，P ＜0．05]、FRC[（1．50±0．27）L vs．（2．25±0．35）L，q ＝8．920，P ＜0．05]명현하강，술후제7천교술전FVC[（2．07±0．53）L vs．（2．70±0．68）L，q ＝5．747，P ＜0．05]、FEV 1．0[（1．35±0．31）L vs．（1．75±0．25）L，q ＝5．568，P ＜0．05]、FEV 1．0／FVC[（57．6±7．4）％ vs．（70．2±6．0）％，q ＝7．382，P ＜0．05]、MVV[（66．3±15．8）L ／min vs．（86．8±16．5） L ／min，q ＝6．038，P ＜0．05]、FRC[（1．68±0．35）L vs．（2．25±0．35）L，q ＝6．779，P ＜0．05]하강명현；술후제7천여제3천비교，FEV 1．0[（1．35±0．31）L vs．（1．05±0．29）L，q ＝4．176，P ＜0．05]、MVV [（66．3±15．8）L ／min vs．（55．3±14．9） L ／min，q ＝3．240，P ＜0．05]유통계학차이，재단기내회복；술후1．5월교술후제3、7천 FVC、FEV 1．0／FVC、MVV 명현호전（P ＜0．05），여술후3、6개월무통계학차이（P ＞0．05），폐공능추우은정；FVC、FEV 1．0、FEV 1．0／FVC、MVV 술후6개월여술전비교무통계학차이（P ＞0．05），표명폐공능이회복도술전수평。등루시험현시술후제7천부2례（8．7％）능견지도5루，차 HR 명현승고、등루시간연장급 SpO2하강균≥5％；술후1．5월등루성공례수여술전무차이（P ＞0．05），술후3개월부등루시간교술전유명현차이（P ＜0．05）。결론복형비반저폐공능폐암환자행전흉강경폐협절제술후1주대심폐공능영향명현，주의가강위수술기관리，1．5월후심폐공능축점대상，회복만의。
    Objective To observe effects of complete video-assisted thoracoscopic lobotomy on heart and lung functions in abdominal obesity patients with lower lung function lung cancer. Methods A total of 23 cases of abdominal obesity patients with lower lung function lung cancer underwent complete video-assisted thoracoscopic lobotomy from July 2013 to June 2014.The heart and lung complications after operation in one week were observed,and lung function and climbing stair tests were conducted on the 2nd, 3rd and 7th postoperative day,as well as at 1 .5,3,and 6 months after operation,respectively. Results After the operation the incidence of heart and lung complications was 39.1 % (9 /23 ).On the 3rd postoperative day,the FVC [(1 .83 ±0.45 )L vs. (2.70 ±0.68)L,q =7.936,P <0.05 ],FEV 1 .0 [(1 .05 ±0.29)L vs.(1 .75 ±0.25 )L,q =9.745,P <0.05 ],FEV 1 .0 /FVC [(53.3 ±7.6)% vs.(70.2 ±6.0)%,q =9.902,P <0.05 ],MVV [(55.3 ±14.9 )L /min vs.(86.8 ±16.5 )L /min,q =9.279,P <0.05],and FRC [(1 .50 ±0.27)L vs.(2.25 ±0.35)L,q =8.920,P <0.05]obviously decreased as compared with preoperative levels.On the 7th postoperative day,the FVC [(2.07 ±0.53)L vs.(2.70 ±0.68)L,q =5.747,P <0.05],FEV 1 .0 [(1 .35 ±0.31 )L vs.(1 .75 ±0.25)L,q =5.568,P <0.05],FEV 1 .0 /FVC [(57.6 ±7.4)% vs.(70.2 ±6.0)%,q =7.382, P <0.05],MVV [(66.3 ±15.8)L /min vs.(86.8 ±16.5 )L /min,q =6.038,P <0.05 ],and FRC [(1 .68 ±0.35 )L vs.(2.25 ±0.35 ) L,q =6.779,P <0.05 ] obviously decreased than those in preoperation.Comparison between 7th and 3rd postoperative day showed the FEV 1 .0 [(1 .35 ±0.31 )L vs.(1 .05 ±0.29 )L,q =4.176,P <0.05 ]and MVV [(66.3 ±15.8) L /min vs.(55.3 ±14.9)L /min,q =3.240,P <0.05]restored rapidly.At the 1 .5 postoperative months,the FVC,FEV 1 .0 /FVC, MVV were improved significantly than those on the 3rd and 7th postoperative day (P <0.05 )and had no statistical differences as compared with 3 and 6 postoperative months (P >0.05),when the lung functions were stabilized.At the 6 postoperative months,the FVC,FEV 1 .0 ,FEV 1 .0 /FVC,and MVV had no significant differences compared with preoperation (P >0.05 ),representing a full recovery of lung functions.Climbing stair tests showed on the 7th postoperative day only 2 cases could climb to the fifth floors (8.7%),with the heart rate significantly increased,climbing time significantly prolonged and SpO2 decreased by more than 5%.At the 1 .5 postoperative months,the number of successful climbing cases had no statistical differences compared with preoperation (P >0.05);at the 3 postoperative months,only the climbing time was longer than preoperation with statistical differences (P <0.05 ). Conclusions Within 1 week after complete video-assisted thoracoscopic lobotomy,the heart and lung functions were effected obviously in abdominal obesity patients with lower lung function lung cancer,and perioperative management should be strengthened.After 1 .5 postoperative months the heart and lung functions will be compensated with satisfactory recovery.
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