肺叶切除与全肺切除术对肺癌患者右心功能的影响

目的:目前临床治疗肺癌的主要方法是手术治疗,但肺切除术会引起肺循环障碍而诱发心功能减退,影响手术效果及安全。本研究针对肺癌患者实施肺叶切除术与全肺切除术,观察患者右心功能各项指标的变化情况,分析不同术式对肺癌患者右心功能的影响,为该病的治疗积累临床经验。方法:选取2010年4月-2012年12月在我院心胸外科接受手术治疗的肺癌患者64例,分为对照组(30例)和研究组(34例)。对照组患者采用全肺切除术,研究组患者采用肺叶切除术。观察并比较两组患者手术前及手术后第八天的中心静脉压(CVP)、动脉血氧分压(PaO2)、心率(HR)、右心室舒张末期容积指数(RVEDVI)、右心室射血分数(RVEF)及肺动脉平均压(mPAP)等右心功能各项指标的变化情况。结果:手术前,两组患者右心功能各指标无明显差异(P0.05);手术后第八天,研究组患者的PaO2水平和RVEF均高于对照组,而HR、RVEDVI及mPAP则低于对照组,两组比较差异显著且具有统计学意义(P0.05)。结论:全肺切除术对肺癌患者右心功能的影响较肺叶切除术更为明显。我们在确保病灶能够被顺利切除的前提下,应选择肺叶切除术,以减少手术对患者右心功能的损害,从而提高手术的安全性及成功率。

Effects of Lobectomy and Pneumonectomy on the Functions of Right Ventricular for Patients with Lung Cancer*

ABSTRACT Objective:The major method at present for lung cancer is operation, but the influences of lobectomy and pneumonectomy on the right ventricular function of patients decline the successful rate and safety for operation. This study was written to explore different effects on the right ventricular functions respectively brought by the lobectomy and pneumonectomy through a clinical trial about the indicators for evaluate the right heart function so as to prospect accumulate experience for the clinical treatment of lung cancer. Methods:64 patients with lung cancer who were treated in the department of cardiothoracic surgery in our hospital between April 2010 and December 2012 were selected and divided into control group and study group. Thirty patients in the control group were treated by the whole lung resection, while another thirty-four patients in the study group were conducted by the pulmonary lobectomy. Then the central venous pressure (CVP), the PaO2, the heart rate (HR), the right ventricular end diastolic volume index (RVEDVI), the right ventricular ejection fraction (RVEF) and the mean pulmonary artery pressure (mPAP) of patients in the two groups were observed and analyzed to evaluate the right heart function. Results:There was no significant difference in the two groups of patients before operation (P>0.05); On the eighth day after the operation, the level of PaO2 in study group was higher than that of the control group (P<0.05); the HR and RVEDVI in the study group were less than those of the patients in the control group (P<0.05); the RVEF of patients in the study group was higher than that of the patients in the control group (P<0.05); the mPAP was lower than that of the control group(P<0.05). Conclusion:It is indicated that the effects of the pneumonectomy could be much worse than the lobectomy on the right heart function for patients with lung cancer. Thus, we should better take the lobectomy in order to ensure the removal of the tumor and to improve the success rate of surgery.