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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。
OBJECTIVE: To summarize the experience of perioperative management of pleural pneumonectomy for lung cancer with pleural metastases and malignant pleural effusion. Methods: From January 1988 to January 2003, 21 cases of lung cancer with pleural metastases and malignant pleural effusion underwent pleural pneumonectomy. Pulmonary primary lesions in the left lung in 8 cases, 13 cases of right lung. Pathological classification: squamous cell carcinoma in 1 case, adenocarcinoma in 12 cases, adenosquamous carcinoma in 2 cases, alveolar cell carcinoma in 6 cases. Results: Postoperative ventilator mechanical ventilation support 12 cases, the average support time of 4.5 hours. No perioperative deaths, no bronchopleural fistula, empyema, bleeding and other serious complications. Follow-up has been 16 cases of death, the survival of 5 to 34 months, the remaining 5 patients were followed up for 24 to 29 months still alive, the median survival time of 18 months. Conclusion: To strengthen the perioperative management and prevent and treat the common complications is the key to reduce the operation risk and promote the rehabilitation of these patients.