呼吸器手術後肺合併症とその対策

From 1962 to 1986, 1838 patients underwent surgery for carcinoma of the lung. Postoperative pulmonary complications were analyzed, and was discussed about the prevention and the treatment of complications. Major risk factors of complications were old age over 70 years old, pneumonectomy and preoperative chemotherapy or radiation. Before 1980 8.7% of patients had complications and 3.8% died following surgery, on the other hand after 1981, although 11.7% had complications only 1.5% died. Patients of 70 years of age or older are increasing, and after 1981 25.8% were 70 years of age or older. The rat of complications in this group of case was 14.9%. In pneumonectomy cases 21.5% developed complications. The main pulmonary complications of all cases were pneumonia, respiratory failure and prolonged parenchymal air leakage. In recent years the incidence of bronchopleural fistula, pulmonary edema and lung abscess decreased. Postoperative pneumonia continued to be a major cause of mortality. Pseudomonas aeruginosa, Klebsiella pneumoniae and Streptococcus viridans were the main pathogens associated with pneumonia. To prevent pneumonia and to maintain the trachea and bronchus clear the bronchofiberscope was frequently used during surgery and in the postoperative period. To prevent pneumonia due to aspiration we used a double lumen tube during thoracotomy and we frequently performed sputum bacteriological examination in the postoperative period. In all cases epidural injection of 2-4 mg morphine were given for postoperative pain relief. In case of combined and wide resection of the anterior chest wall, reconstruction of the chest wall with homogenous bone graft was effective in preventing the development of respiratory failure. Recently, 25 case receiving “neoadjuvant” chemotherapy, i.e. chemotherapy performed preoperatively in those cases in which the initiated indications of surgery were unclear-surgery-enabling chemotherapy, underwent surgery for carcinoma of the lung. This group of patients showed somewhat different tendencies from other cases in terms of their postoperative course. The low incidence of complication observed was attributed to careful preoperative evaluation, selection of the appropriate surgical procedure nd inclusion of careful management of patient in the perioperative period.