文档介绍：Complications of Surgery
Introduction
Surgical resection remains a mainstay of therapy for patients with carcinoma of the lung.
Unfortunately, any surgical intervention carries with it the potential of morbidity and mortality.
Although many advances have occurred in the preoperative, intraoperative, and postoperative
care of these patients to minimize the risk of surgery, complications still
after surgery can never be totally eliminated, but they can be minimized by careful attention to
the many details of prevention. plications do occur, proper management usually
yields a satisfactory result. Prevention includes accurate preoperative assessment,
meticulous surgical technique, and a knowledge of surgical maneuvers to minimize potential
problems.
Preoperative Assessment
Traditional attempts to assess surgical morbidity and mortality after pulmonary resection have
primarily focused on clinical assessment and static pulmonary function testing, such as
spirometry, radionuclide scans, and temporary unilateral pulmonary artery balloon occlusion.
Nagasaki and associates2 studied 961 patients undergoing surgical treatment for carcinoma
of the lung. Variables including age, gender, cell type, extent of resection, cardiopulmonary
status, and stage of disease were evaluated. The authors found that certain high-risk groups
could be identified:
1. patients older than 70 years of age in whom a major resection is necessary;
2. patients with a positive cardiac history;
3. patients with severely restricted pulmonary reserve, regardless of age.
Gender, stage of disease, and cell type were found to have little influence on the frequency of
plications. Kohman and colleagues3 studied 476 patients undergoing
thoracotomy more thoroughly by analyzing 37 preoperative risk factors, including the forced-
expiratory volume at 1 second (FEV1) and arterial blood gases, and their effects on morbidity
and mortality. Only three