Background and objective: The aim of this study is to analyze the impact on the cough after radical systematic mediastinal lymphadenectomy and prevention of refractory cough with mediastinal fat to fill the residual cavity after radical systematic mediastinal lymphadenectomy.
Methods: Sixty patients clinically diagnosed of lung cancer were selected according to the adopt standardization, from January 2008 to December 2008. All of the patients were divided into two groups randomly: the filling-fat group and the non-filling-fat group. The surgical information such as operation duration time bleeding volume during operation, post-operation bleeding volume were recorded. After one month, FACT-L and LCQ were completed.
Results: There are no remarkably differences between the operation duration time, bleeding volume in operation and 1st postoperation day's drainage volume of the two groups. There's significant difference in the scores of cough at night after taking off the chest tube, as well as in the scores of LCQ after one month and in the scores of last items of FACT-L.
Conclusions: Filling the fat of the mediastinal to cover the residual cavity left by completely systematic mediastinal lymphadenectomy can reduce the refractory cough after surgery, and can also improve the quality of the life. It has no effect on the the operation duration time, bleeding volume in operation and 1st post-operation day's drainage volume of the patients.
背景与目的: 肺癌手术系统性清扫淋巴结能一定程度上提高肺癌患者生存率，但也会造成术后并发症增多，例如乳糜胸、喉返神经损伤致声音嘶哑、顽固性咳嗽等。目前国内外尚无外科手术方法改进以减少顽固性咳嗽的发生。本研究旨在探讨前纵隔脂肪填塞残腔是否可减少顽固性咳嗽的发生。
方法: 2008年1月-2008年12月，依纳入标准收治右肺癌患者60例，按随机数字表随机分为使用前纵隔脂肪填塞上纵隔淋巴结清扫遗留的残腔实验组（30例）和未使用前纵隔脂肪填塞上纵隔淋巴结清扫遗留的残腔对照组（30例）。术中依据分组采取不同的方法处理上纵隔淋巴结清扫遗留残腔，记录两组患者术后第1天引流量、拔管时间、住院时间、拔管前后日间和夜间咳嗽评分等具体外科临床资料。分别随访两组患者出院后术后咳嗽情况，并指导患者填写咳嗽量化评分表和FACT-L评分表。
结果: ① 两组患者手术时间、术中失血量、术后第1天胸引量、拔管时间、住院天数无明显差异；②两组患者在拔管前日间、夜间咳嗽及拔管后夜间咳嗽评分无明显差异，在拔管后日间咳嗽评分有统计学差异；③两组患者术后随访咳嗽评分表评分有明显差异；④两组患者FACT-L评分中生理状况、社会/家庭状况、情感状况、功能状况、附加关注五项评分中，后三项评分两组患者有明显差异。
结论: 前纵隔脂肪填塞残腔能有效减少术后顽固性咳嗽的发生，提高患者生存质量。