[1]张六伢* 李远静 陈维 孟小鹏.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[J].中国微创外科杂志,2015,15(10):917-921.
　Zhang Liuya,Li Yuanjing,Chen Wei,et al.Effects of Complete Video-assisted Thoracoscopic Lobotomy on Heart and Lung Functions in Abdominal Obesity Patients with Lower Lung Function Lung Cancer[J].Chinese Journal of Minimally Invasive Surgery,2015,15(10):917-921.
点击复制

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()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
15
期数:
2015年10期
页码:
917-921
栏目:
临床研究
出版日期:
2015-10-20

文章信息/Info

Title:
Effects of Complete Video-assisted Thoracoscopic Lobotomy on Heart and Lung Functions in Abdominal Obesity Patients with Lower Lung Function Lung Cancer
作者:
张六伢* 李远静 陈维 孟小鹏
（绍兴第二医院胸心外科，绍兴312000）
Author(s):
Zhang Liuya;  Li Yuanjing;  Chen Wei;  et al.
Department of Cardiothoracic Surgery, Shaoxing Second Hospital, Shaoxing 312000, China
关键词:
腹型肥胖; 肺癌; 全胸腔镜; 肺叶切除; 低肺功能
Keywords:
Abdominal obesity; Lung cancer; Complete video-assisted thoracoscopy; Lobotomy; Lower lung function
分类号:
R734.2
文献标志码:
A
摘要:
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］、FEV1.0［(1.05±0.29) L vs. (1.75±0.25) L，q=9.745，P<0.05］、FEV1.0/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］、FEV1.0［(1.35±0.31) L vs. (1.75±0.25) L，q=5.568，P<0.05］、FEV1.0/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，FEV1.0［(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、FEV1.0/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、FEV1.0、FEV1.0/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。
Abstract:
ObjectiveTo observe effects of complete video-assisted thoracoscopic lobotomy on heart and lung functions in abdominal obesity patients with lower lung function lung cancer.MethodsA 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. ResultsAfter 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］, FEV1.0 ［(1.05±0.29) L vs. (1.75±0.25) L, q=9.745, P<0.05］, FEV1.0/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］, FEV1.0 ［(1.35±031) L vs. (1.75±0.25) L, q=5.568, P<0.05］, FEV1.0/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 FEV1.0 ［(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, FEV1.0/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, FEV1.0, FEV1.0/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). ConclusionsWithin 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.

参考文献/References:

[1]宋楠,姜格宁,王海峰.肥胖对肺切除术后并发症发生的影响.中国胸心血管外科临床杂志,2013,20(1):74-77.
[2]中华人民共和国国家卫生和计划生育委员会.中华人民共和国卫生行业标准:成人体重判定(WS/T428-2013).北京:中国标准出版社,2013.2.
[3]李迎新,蔡海波.胸腔镜肺叶切除术术后早期肺功能变化.济宁医学院学报,2013,36(6):410-414.
[4]WHO.Obesity:preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser,2000,894:i-xii,1-253.
[5]万学红,卢雪峰,主编.诊断学.第8版.北京:人民卫生出版社,2013.540.
[6]古桂雄.肥胖与呼吸系统疾病.实用儿科临床杂志,2011,26(19):1470-1471.
[7]张蒙,邓笑伟.超重、肥胖成人肺功能及代谢指标相关研究.中国综合临床,2014,30(1):44-48.
[8]张六伢,李远静,陈维,等.腹型肥胖对胸腔镜肺叶切除围手术期肺功能的影响.中国医师进修杂志,2014,37(29):41-44.
[9]王安生,刘以尧,段贵新,等.肺癌患者完全胸腔镜与开胸肺叶切除术后近期生活质量的比较.中国微创外科杂志,2014,14(5):439-441.
[10]赵永胜,赵丛雯,秦光明,等.99Tc-MAA肺灌注显像预测肺癌患者肺切除术后残余肺功能.安徽医学,2008,29(7):519-521.
[11]李剑锋,李运,王俊,等.全胸腔镜下肺叶切除技术要点分析.中国微创外科杂志,2009,9(1):30-32.
[12]Ramos R, Masuet C, Gossot D. Lobectomy fur early-stage lung carcinoma: a cost analysis of full thoracoscopy versus posterolateral thracotomy. Surg Endosc,2012,26(2):431-437.
[13]李岩.胸腔镜下肺癌根治术对低肺功能和血清血管内皮生长因子的影响.中国实用医刊,2013,40(23):93-95.
[14]侯升帅.中至重度低肺功能患者肺切除术56例临床分析.中国医师进修杂志,2009,32(8):11-12.
[15]朱勇,杜贾军,陈景寒.登楼试验在低肺功能肺癌患者术前心肺功能评估中的应用.中华全科医师杂志,2007,6(10):616-619.
[16]董静思,毛友生, 严少平,等.常规肺功能检测联合登楼试验在预测非小细胞肺癌患者术后心肺并发症中的作用.中华肿瘤杂志,2014,36(1):53-58.

备注/Memo

备注/Memo:
*通讯作者，E-mail：zhangly956888@126.com
更新日期/Last Update: 2016-02-03