«上一篇/Previous Article|本期目录/Table of Contents|下一篇/Next Article»

《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

24卷

期数:

2018年02期

页码:

156-158,161

栏目:

出版日期:

2018-03-20

文章信息/Info

Title:

Risk assessment of lung cancer combined with pulmonary fibrosis in lung cancer radical surgery

作者:

王硕; 张军; 严一杰; 孟繁杰; 关志宇

天津医科大学第二医院胸外科，天津300211

Author(s):

WANG Shuo;  ZHANG Jun;  YAN Yi-jie;  Meng Fan-jie;  GUAN Zhi-yu

Department of Thoracic Surgery, The Second Hospital ，Tianjin Medical University, Tianjin 300211,China

关键词:

肺纤维化;  非小细胞肺癌;  肺癌根治术

Keywords:

pulmonary fibrosis;  non-small cell lung cancer ; lung cancer radical surgery

分类号:

R734.2

DOI:

-

文献标志码:

A

摘要:

目的：分析肺癌合并肺纤维化患者肺癌根治术的预后，并探讨此类患者手术风险的评估。方法 ：回顾性分析373例肺癌患者行肺切除术的病理组织，以是否有肺纤维化分为两组（I组和Ⅱ组），对二 者术后并发症、临床转归、生存率等相关指标进行比较，并按照不同手术切除方式进行亚组分析。结果 ：在所有373个标本中，有21例确诊为肺纤维化，两组在年龄[（65±12）岁 vs （64±9）岁]、吸烟史 （76% vs 63%）、1秒钟用力呼气容积[（2.41±1.25）L·min－1 vs（2.49±1.38）L·min－1]、用力 肺活量[（3.08±1.53）Lvs （3.44±1.42）L]没有显著差异，但肺纤维化患者男性更多（71% vs 51%， P<0.05）。肺纤维化患者的手术死亡率高于对照组（14% vs 4%，P <0.01)，亚组分析显示肺纤维化患者 全肺切除术（２0% vs 9%，P<0.01）和肺叶切除术（13% vs 4%，P<0.01）死亡率较对照组高。肺纤维化 患者术后肺损伤发生率较高（42% vs 5%，P<0.01），住院时间较长[（15.70±4.11）d vs （9.28±3.03）d，P<0.05]。在肺纤维化患者中，5例患者出现术后急性呼吸窘迫综合征，其中3例死亡 。术后急性呼吸窘迫综合征的发生与术前低DLCO[（4.01±1.40） mmol·min－1·kPa－1·L－1，（4.5 ±1.65） mmol·min－1·kPa－1·L－1，P<0.05]和KCO[ （0.92±0.33）mmol·min－1·kPa－1·L－1 ，（1.01±0.46） mmol·min－1·kPa－1·L－1，P<0.05]以及高术前CPＩ（45.68±7.41， 32.22±17.21，P<0.01）有关。结论：肺纤维化患者行肺癌根治术术后发病率和死亡率增加,与术前低气 体弥散指标和高CPI有关。术前仔细评估其肺功能受损程度以选择合适的病人，对其行肺癌切除术的生存 获益是十分必要的。

Abstract:

Objective: To analyze the prognosis of patients with lung cancer combined with pulmonary fibrosis in lung cancer radical surgery and to evaluate the surgical risk of these patients. Methods: Making retrospective analysis on patients’ lung tissue （2010- 2016）,which were divided into two groups based on pulmonary fibrosis (I and Ⅱ group). The postoperative complications, clinical outcomes, survival rates and other related indicators were compared, and subgroup analysis was performed by different surgical excision methods. Results: In all 373 cases, 21 cases were diagnosed with pulmonary fibrosis, the two groups showed no significant differences in age [(65±12) years old vs( 64± 9) years old], smoking（76% vs 63%）, forced expiratory volume in 1 second [(2.41±1.25) L·min－1 vs (2.49±1.38) L·min－1] , forced vital capacity[ （３.08 ±1.53）L vs （3.44 ± 1.42） L]. However, there were more male patients with pulmonary fibrosis (71% vs 51%, P < 0.05). The procedure showed that the mortality rates of patients with pulmonary fibrosis were higher than the control group (14% vs 4%，P <0.01). Subgroup analysis showed that the mortality rates in patients with pulmonary fibrosis of pneumonectomy (20% vs 9%, P<0.01) and lobectomy（13% vs 4%，P <0.01) were higher than the control group. The incidence of acute lung injury in patients with pulmonary fibrosis was higher （４2% vs 5%, P < 0.01）, and the length of hospitalization was longer (15.70±4.11 vs 9.28±3.03 days, P < 0.05). In patients with pulmonary fibrosis, 5 patients had postoperative acute respiratory distress syndrome, 3 of which were fatal. Postoperative acute respiratory distress syndrome occurred with preoperative low DLCO [(4.01±1.40) mmol·min－1·kPa－1·L－1，（4.5±1.65） mmol·min－1·kPa－1·L－1，P<0.05] and KCO[（0.92±0.33） mmol·min－1·kPa－1·L－1， (1.01±0.46 )mmol·min－1·kPa－1·L－1，P<0.05], as well as the high preoperative CPI （45.68±7.41，32.22±17.21，P<0.01）. Conclusion: The incidence and mortality of postoperative patients with lung fibrosis combined with non-small cell lung cancer are increased due to low preoperative gas dispersion and high CPI. In patients with lung fibrosis combined with lung cancer, it is necessary to select patients by assessing the degree of damage to their lung function.

参考文献/References:

[1] Vainshelboim B, Oliveira J, Yehoshua L, et al. Exercise training-based pulmonary rehabilitation program is clinically beneficial for idiopathic pulmonaryfibrosis[J]. Respiration, 2014,88(5):378
[2] Martinez F J, Chisholm A , Collard H R, et al. The diagnosis of idiopathic pulmonary fibrosis: current and future approaches[J]. Lancet Respir Med, 2017 , 5(1): 61
[3] Luo F , Le N B, Mills T, et al. Extracellular adenosine levels are associated with the progression and exacerbation of pulmonary fibrosis[J]. FASEB J, 2016 , 30(2): 874
[4] Craig V J, Zhang L, Hagood J S, et al. Matrix metalloproteinases as therapeutic targets for idiopathic pulmonary fibrosis[J]. Respir Cell Mol Biol, 2015 , 53(5): 585
[5] Nakamura Y, Suda T. Idiopathic pulmonary fibrosis: Diagnosis and clinical manifestations[J]. Clin Med Insights Circ Respir Pulm Med, 2015, 9(Suppl 1): 163
[6] Blackwell T S, Tager A M, Borok Z, et al. Future directions in idiopathic pulmonary fibrosis research[J]. Respir Crit Care Med, 2014 ,189(2): 214
[7] Weng T, Poth J M, Karmouty-Quintana H, et al. Hypoxia-induced deoxycytidine kinase contributes to epithelial proliferation in pulmonary fibrosis[J]. Respir Crit Care Med, 2014, 190(12): 1402
[8] Ley B, Brown K K, Collard H R. Molecular biomarkers in idiopathic pulmonary fibrosis[J]. Am J Physiol Lung Cell Mol Physiol, 2014 ,307(9): L681
[9] Cheresh P, Kim S J, Tulasiram S, et al. Oxidative stress and pulmonary fibrosis[J]. Biochim Biophys Acta, 2013,1832(7):1028
[10] Barkauskas C E, Noble P W. Cellular mechanisms of tissue fibrosis. 7. New insights into the cellular mechanisms of pulmonary fibrosis[J].Physiol Cell Physiol, 2014 , 306(11): C987
[11] Huang L S, Mathew B, Li H Q, et al. The mitochondrial cardiolipin remodeling enzyme lysocardiolipin acyltransferase is a novel target in pulmonary fibrosis[J]. Respir Crit Care Med, 2014 ,189(11): 1402
[12] Yang D X, Yuan W D, Lv C J, et al. Dihydroartemisinin supresses inflammation and fibrosis in bleomycine-induced pulmonary fibrosis in rats[J]. Int J Clin Exp Pathol, 2015, 8(2): 1270

相似文献/References:

[1]董笑影 综述,魏 蔚 审校. 沙利度胺治疗肺纤维化新进展[J].天津医科大学学报,2015,21(03):272.
[2]徐雷倩,曹 洁.FSTL1促进间歇性低氧诱导的肺成纤维细胞活化[J].天津医科大学学报,2019,25(05):446.
　XU Lei-qian,CAO Jie.FSTL1 promotes intermittent hypoxia-induced lung fibroblast activation[J].Journal of Tianjin Medical University,2019,25(02):446.
[3]闫喆.主动循环呼吸技术对进展性纤维化性间质性肺病患者的治疗效果[J].天津医科大学学报,2022,28(04):414.
　YAN Zhe.Effect of active cycle of breathing technologies on patients with progressive fibrotic interstitial lung disease[J].Journal of Tianjin Medical University,2022,28(02):414.

备注/Memo

备注/Memo:

文章编号 １００６－８１４７（２０18）０2-0156-03
基金项目 天津市卫计委重点攻关项目基金资助（15KG138）
作者简介 王硕(1985-)，男，主治医师，硕士，研究方向：胸部肿瘤外科的临床及基础研究；通信作者：关志宇 ，E-mail:rrr71@126.com。

常用功能

更新日期/Last Update: 2018-03-20