Application of Blocking Unilateral Main Pulmonary Artery in Pulmonary Lobectomy of Lung Cancer

摘要

OBJECTIVE To explore the application of blocking the unilateralmain pulmonary artery (MPA) in pulmonary lobectomy (PL) forpatients with stage Ⅱ and Ⅲ lung cancer, and to retrospectivelyanalyze the methods of surgery for blocking the unilateral mainpulmonary artery, perioperative indications, intraoperativeconcerns and postoperative cardio-pulmonary complications.METHODS During a period from January 2006 to January 2008,intra-pericardial, or extra-pericardial separation and blockade ofthe left or right MPA followed by completion of various PLs wereconducted for 30 lung cancer patients in stage-Ⅱ to Ⅲ with ill-defined anatomic structure of the pulmonary hilum and difficultpulmonary angiodiastasis.RESULTS In the 30 patients, 5 were diagnosed as stage-Ⅱb, 11stage-Ⅲa, and 14 stage-Ⅲb. During the surgery, giant tumors atthe superior pulmonary lobe, with a diameter of over 10 cm, wereseen in 13 cases, in which tumor invasion in the extra-pericardiacpulmonary artery was found in 5 cases. Hilar lymphadenectasiswith severe tumor adhesion to pulmonary blood vessel couldbe seen in 20 cases and partial tumorous invasion in thepericardium in 7. In most of the cases, adhesions existed aroundthe tumor, aorta, superior vena, and azygous vein. Invasion ofthe laryngeal and vagus nerves on the left side was found in 3cases. Of the 30 patients, simple PL was conducted in 12, andsleeve lobectomy combined with a pulmonary arterioplasty in18 cases. With a blockade of unilateral MPA, no intraoperativehemorrhea of pulmonary blood vessels occurred during surgery,when there was a clear surgical field of vision. Both PL andlymphadenectomy were smoothly completed in the 30 patients.The healthy pulmonary lobes with normal function were keptand total pneumonectomy was avoided. The time of blocking thepulmonary artery ranged from 10 to 30 min, and intraoperativeblood loss was from 200 to 300 ml. Postoperative complicatedacute pulmonary edema occurred in 5 patients and tachycardia in7 cases. Nevertheless, all patients recovered and left the hospitalafter treatment. No severe cardiopulmonary complications werefound in all patients of the group.CONCLUSION Blocking the unilateral MPA is effective todecrease the risk of intraoperative hemorrhea in the PL. It canshorten the time of surgery, improve the excision rate of lungcancer, and cut down on the rate of total pneumonectomy.