慢性腎不全合併肺癌切除例における周術期管理と手術適応に関する臨床的検討

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This study on perioperative management and indications analized 15 patients (796 resected lung cancer) with chronic renal failure (10 dialyzed, 5 ^non-dialyzed). Renal failure causes were mainly diabetic nephrophathy and chronic glomerulonephritis; six patients also had cerebrovascular or ischemic heart disease. Fourteen patients received lobectomies; six also had muscle-lapping of the bronchial stump. The dialyzed group showed higher serum creatinine levels; post 24-hour urinary output was significantly less than the control group. The non-dialyzed group had more urinary output than the control group due to low-dose dopamine administrations. Postoperatively, six patients developed infections; three developed pulmonary edema but there was no occurrence of broncho-pleural fistula. In the non-dialyzed patients, renal function was preserved by an appropriate infusion level. The five-year survival rate was 10.1% in the renal failure group, compared with 44.4% in all resected patients (p<0.05), including five cancer deaths and seven other causes. Pulmonary resection is possible for chronic renal failure after careful examination of preoperative cardiopulmonary function and close monitoring of water-balance including postoperative dialysis. Because of the increase in diabetic nephropathy with ischemic heart disease and a poorer prognosis than for non-diabetics, operative indications are prudent for advanced lung cancer with chronic renal failure.
東京女子医科大学の論文
2000-12-25

慢性腎不全合併肺癌切除例における周術期管理と手術適応に関する臨床的検討

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