肺癌胸膜全肺切除术的围术期处理

目的：总结对于肺癌伴胸膜转移和恶性胸水行胸膜全肺切除手术的围术期处理经验。方法：1988年1月～2003年1月对21例肺癌伴胸膜转移和恶性胸水患者行胸膜全肺切除术。肺部原发病灶位于左肺8例，右肺13例。病理分类：鳞状细胞癌1例，腺癌12例，腺鳞癌2例，肺泡细胞癌6例。结果：术后呼吸机机械通气支持12例，平均支持时间4．5小时。无围手术期死亡，无支气管胸膜瘘、脓胸、大出血等严重并发症。随访已死亡16例，生存期为5～34个月，其余5例患者随访24～29个月仍生存，全组中位生存时间18个月。结论：加强围术期处理，对常见并发症重点防范、早期治疗，是降低手术风险、促进此类患者康复的关键。

Perioperative management of pleuro-pneumonectomy for primary lung cancer with dissemination and malignant pleural effusion

Objective:To review the perioperative management of pleuro-pneumonectomy for primary lung cancer with dissemination and malignant pleural effusion.Methods:From Jan.1988 to Jan.2003,21 patients of primary lung cancer with dissemination and malignant pleural effusion were treated chiefly by operation.The surgical procedures included left pleuro-pneumonectomy in 8 and right pleuro-pneumonectomy in 13 patients.Results:All patients recovered postoperatively.There were no severe surgical complications such as bronchopleural fistula,empyema and hemorrhage.Follow-up showed that 16 patients have died at 5 to 34 months after the operation.Other patients were still alive at 24 to 29 months.Conclusion:Proper selection,early detection and correct management of postoperative complication are important to improve surgical outcome.