摘要
手术技术和围手术期护理的进步大大降低了肺切除术后的手术发病率和死亡率。已经提出了各种功能可操作性的单一和组合参数来评估手术风险。肺功能检查可充分评估肺风险,基线或应激心电图、超声心动图和心脏核研究可评估心脏风险。正常或仅轻微肺功能受损(一秒钟用力呼气量(FEV1)和肺一氧化碳转移因子(TL,CO) >或=预测的80%)且无心血管危险因素的患者可在不进一步调查的情况下进行肺切除术至全肺切除术。对于其他人,运动测试,肺分裂功能研究,或这两种方法的组合是推荐的。运动试验,最常见的是作为一种症状限制试验,测量最大摄氧量(V'O2,max),评估肺和心血管储备。A V'O2,最大值<10 mL.kg(-1).min(-1)通常被认为对任何切除都是禁止的,值>20 mL.kg(-1).min(-1)或>是预测正常的75%,对于主要切除是安全的。分裂功能研究是对各种参数的预测术后(ppo)值的基于放射性核素的估计。目前使用的ppo参数有FEV1-ppo、TL、CO-ppo以及最近使用的V'O2、max-ppo。建议安全切除的截止值为:对于FEV1-ppo和TL,CO-ppo bb0或= 40%; and for V'O2,max > or = 35% pred, combined with an absolute value of > or = 10 mL.kg(-1).min(-1). The lowest acceptable ppo-values will still have to be established by additional prospective studies. In the long-term, resections involving not more than one lobe usually lead to an early functional deficit followed by later recovery. The permanent functional loss in pulmonary function is small (< or = 10%) and exercise capacity is only slightly reduced or not at all. Pneumonectomy, on the other hand, leads to an early permanent loss of about 33% in pulmonary function and 20% in exercise capacity. Thus, pulmonary function tests alone overestimate the functional loss after lung resection.