CAJ | 학술논문

目的：探讨肺门及叶间钙化淋巴结对肺癌手术的影响及应对方法。方法回顾性分析该院胸外科2012年5月-2014年5月所做的148例肺癌手术，42例患者肺门及或叶间肺动脉处存在粘连紧密的钙化淋巴结。以有无此类钙化淋巴结将所有患者分为两组，即钙化淋巴结组和无钙化淋巴结组（对照组）统计每组的各项指标，分析钙化淋巴结对肺癌手术的影响，总结肺门及叶间钙化淋巴结的术中处理方法及体会。结果全部患者手术顺利，钙化淋巴结组手术平均时间较对照组手术时间延长[(196.0±55.4) min对(125.1±47.8) min]、平均术中出血明显增加[(577.8±214.4) mL对(413.9±193.5) mL]，差异有统计学意义（P<0.05）。肺门及叶间钙化淋巴结组术中平均出血量明显高于对照组，差异有统计学意义（P<0.05）。26例接受胸腔镜手术的钙化淋巴结组患者中，14例中转的平均出血量高于全腔镜手术的近一倍，差异有统计学意义（P<0.05）。结论肺门及叶间钙化淋巴结增加了肺癌手术，尤其是胸腔镜手术的难度及风险，手术前应选择恰当的手术方式，术中应谨慎操作，必要时根据术中具体情况，更改手术方式，保障患者的生命安全。
목적：탐토폐문급협간개화림파결대폐암수술적영향급응대방법。방법회고성분석해원흉외과2012년5월-2014년5월소주적148례폐암수술，42례환자폐문급혹협간폐동맥처존재점련긴밀적개화림파결。이유무차류개화림파결장소유환자분위량조，즉개화림파결조화무개화림파결조（대조조）통계매조적각항지표，분석개화림파결대폐암수술적영향，총결폐문급협간개화림파결적술중처리방법급체회。결과전부환자수술순리，개화림파결조수술평균시간교대조조수술시간연장[(196.0±55.4) min대(125.1±47.8) min]、평균술중출혈명현증가[(577.8±214.4) mL대(413.9±193.5) mL]，차이유통계학의의（P<0.05）。폐문급협간개화림파결조술중평균출혈량명현고우대조조，차이유통계학의의（P<0.05）。26례접수흉강경수술적개화림파결조환자중，14례중전적평균출혈량고우전강경수술적근일배，차이유통계학의의（P<0.05）。결론폐문급협간개화림파결증가료폐암수술，우기시흉강경수술적난도급풍험，수술전응선택흡당적수술방식，술중응근신조작，필요시근거술중구체정황，경개수술방식，보장환자적생명안전。
Objective To study on the effect of hilar and interlobar calcified lymph nodes on lung cancer operation and the corre-sponding coping approach. Methods A retrospective analysis was conducted on the 148 cases underwent lung cancer operation in Department of Thoracic Surgery of our hospital from May 2012 to May 2014. Of them, 42 cases had closely accretive calcified lymph nodes in hilus of lung or lobar pulmonary artery. The patients were divided into two groups, the calcified lymph nodes group and non-calcified lymph nodes(control group) in accordance with whether the patients had closely accretive calcified lymph nodes. The indexes of the two groups were counted. The effect of calcified lymph nodes on the lung cancer operation was analyzed. And the intraoperative dealing ways and experience for hilar and interlobar calcified lymph nodes were summarized. Results The oper-ation of all the patients was implemented successfully. The mean duration of operation was much longer in the calcified lymph nodes group than in the control group[(196.0±55.4) min vs(125.1±47.8) min], the mean intraoperative blood loss was much more in the calcified lymph nodes group than in the control group [(577.8±214.4) mL vs (413.9±193.5) mL], with statistically significant difference, P<0.05. The calcified lymph nodes group had much more mean intraoperative blood loss than the control group, with statistically significant difference, P<0.05. Of the 26 cases with thoracoscope-assisted thoracic surgery in calcified lymph nodes group, the average amount of bleeding of 14 cases converted to open chest operation was nearly more than doubled than those with thoracoscope-assisted thoracic surgery with statistically significant difference, P<0.05. Conclusion Hilar and interlobar calcified lymph nodes increase the difficulty of lung cancer operation, especially the difficulty and risk of thoracoscope-assisted thoracic surgery. Appropriate surgical mode should be selected before the surgery, and the surgery should be operated cautiously, changing the surgical mode in accordance with the conditions of the patients when necessary so as to ensure the life safety of the patients.