전산화 폐관류주사를 이용한 폐절제술후 폐기능의 예측

  • 오덕진 (충남대학교 의과대학 흉부외과학교실) ;
  • 이영 (충남대학교 의과대학 흉부외과학교실) ;
  • 임승평 (충남대학교 의과대학 흉부외과학교실) ;
  • 유재현 (충남대학교 의과대학 흉부외과학교실) ;
  • 나명훈 (충남대학교 의과대학 흉부외과학교실)
  • Oh, Duck-Jin (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Chungnam National University) ;
  • Lee, Young (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Chungnam National University) ;
  • Lim, Seung-Pyeung (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Chungnam National University) ;
  • Yu, Jae-Hyun (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Chungnam National University) ;
  • Na, Myung-Hoon (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Chungnam National University)
  • 발행 : 1996.08.01

초록

폐절제술후 발생할 수 있는 호흡부전증을 예방하고 수술후 사망율을 줄이기 위해 수술범 위를 조정하 는 것이 필요하며 이를 위해서는 수술전에,수술후의 폐기능을 예측할 수 있어야 한다 술후 폐기능을 예측하는 방법은 여러 가지가 .있으나 폐관류주사법이 편리하고 환자에게도 위 험도가 작으며 또한 비교 적 정확하고 비용이 적게드는 방법으로 알려져 있다. 충남대 학교병 원 흉부외과에서 폐절제술을 시행한 34명을 대상으로 수술전 폐관류주사법을 이용하여 수술후 폐기능 예측치를 계산하고 수술후 평균20일에 폐기능검사를 실시하여 예측치와실측치의 관계 를 비교분석하였다. 폐엽절제술후 폐기능 예측치가 일측전폐절제술후 폐기능 예측치보다 훨신 더 좋은 상관관계를 보였으며 그 중에서도 1초내 강제호기량이 상관계수 R=0.693으로 가장 높은 상관관계를 나 타내었다. 폐실질의 손실없이 개흉술만 시 행한 대조군에서 수술전후의 상관관계는 1초내 강제호기 량이 상관계수 R=0.871 이 었으며 강제폐활량이 R=0.896으로 폐 절제수술을 시 행한군에 비해 매우 높은 상관 관계를 보이는 것으로보아 수술후 폐기능검사치는 개흉술 자체만으로도 영향을 받 嗤\ulcorner폐절제수술을 시행한군에서 휠신 더 영향을 받는것을 알수 있었다.

A preoperative prediction of postoperative pulmonary function after the pulmonary resection should be made to prevent serious complications and postoperative mortality. There are several methods to predict postoperative lung function but the 99m7c-MAA perfusion lung scan is known as simple, inexpensive and easily tolerated method for patients. We studied the accuracy of the perfusion lung scan in predicting postoperative lung function on 34 patients who received either the resection of one lobe(17 patients) or 2 lobes(2 patients) or pneumonictomy(15 patients). We performed pulmonary function test and lung scan immediately before the operation and calculated the postoperative lung function by substracting the regional lung function which will be rejected. We compared this predictive value to the observed pulmonary function which was done 20 days after the surgery. We also compared the data achieved from 12 patients ho received open thoracotomy due to intrathoracic disease that are not confined in the lung. The correlation coefficient between the predicted value and observed value of FEVI .0 was 0.423, FVC was 0.557 in the pneumonectomy group and FEVI . 0 was 0.693, FVC was 0.591 in the lobectomy group. The correlation coefnclent between the'postoperative value and preoperative value of FEVI .0 was 0.528, FVC was 0.502 in the resectional group and FEVI .0 was 0.871, FVC was 0.896 in the comparatives. We concluded that the perfusion lung scan is accllrate in predicting post-resectional pulmonary function.

키워드

참고문헌

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