肺癌外科手术前要做哪些准备？

肺癌外科手术前准备包括肿瘤学准备和外科学准备两方面。一旦经过肺癌诊断及分期检查确认为符合外科手术适应症的肺癌患者 , 主治医生会制定一系列与肺切除术相关的术前临床检查。

详细询问病史并了解全身健康状况, 完成重要器官功能的检查，了解是否有药物过敏史和既往手术史。外科重点是肺功能和心脏功能检查。肺功能检查用以确认余肺是否能够代偿。血气分析用以判断血中氧和二氧化碳的排泄功能,心电图和心脏超声检查以确认心脏能否承受开胸肺切除手术。

医护人员还会指导患者如何锻炼肺功能和有效咳嗽。

肺癌患者手术前一定要戒烟，吸烟对肺部手术有不利的影响。吸烟可以刺激呼吸道，减弱气管内纤毛对粘液的清除能力，导致痰液淤积，影响术后排痰；开胸手术本身对健康肺组织就是一种损伤，肺切除术后余肺很容易出现肺不张，出现肺部感染的机率明显增加。医护人员会告诫烟民立即停止吸烟并于术前至少达到戒烟 2_3 周。

术前一天要进行灌肠或服泻药,术前晚10时禁饮食,常规服用催眠药,进手术室前摘除所有的首饰、隐形眼镜、假牙假发等。

对于合并其他疾病的老年患者，术前积极处理治疗合并疾病十分重要。

肺功能测定临床常用的有肺活量（VC），最大通气量（MVV），第一秒用力呼气量（FEV1）。第一秒用力呼气量占用力肺活量的百分率（FEV1%）。一般认为当VC占预计值百分率（VC％）≤50％，MVV占预计值百分率（MVV％）≤50％，FEV1   或FEV1％<50％时剖胸术的风险非常大。一般认为MVV% ≥70% 者手术无禁忌，69％～50％者应慎重考虑；49％～30％者应尽量保守或避免手术，30％以下者禁忌手术。

Doctors use many tests to diagnose cancer and determine if it has spread from the lung. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible or more information is needed, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized, but they can never be used to actually diagnose lung cancer. Only a biopsy can do that. Your doctor may consider these factors when choosing a diagnostic test:

• Location of the suspected cancer
• Size of the suspected cancer
• Age and medical condition
• The type of cancer
• Severity of symptoms
• Previous test results

In addition to a physical examination, the following tests may be used to diagnose lung cancer:

Biopsy. A biopsy is the only way to make a diagnosis of lung cancer. A biopsy is the removal of a small amount of tissue for examination under a microscope. The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease). If cancer cells are present, the pathologist will determine if it is small cell lung cancer or NSCLC, based on its appearance under the microscope.

Common procedures doctors use to obtain tissue for the diagnosis and staging of lung cancer are listed below:

Sputum cytology. If there is reason to suspect lung cancer, the doctor may ask a person to cough up some phlegm so it can be examined under the microscope. A pathologist can find cancer cells mixed in with the mucus.

Bronchoscopy. In this procedure, the doctor passes a thin, flexible tube with a light on the end into the mouth or nose, down through the main windpipe, and into the breathing passages of the lungs. A surgeon or a pulmonologist, a medical doctor who specializes in the diagnosis and treatment of lung disease, may perform this procedure. The tube lets the doctor see inside the lungs. Tiny tools inside the tube can take samples of fluid or tissue, so the pathologist can examine them. Patients are given mild anesthesia (medication to put them to sleep) during a bronchoscopy.

Needle aspiration. After numbing the skin, a special type of radiologist, called an interventional radiologist, inserts a small needle through the chest and directly into the lung tumor. The doctor uses the needle to aspirate (suck out) a small sample of tissue for testing. Often, the radiologist uses a chest CT scan or special x-ray machine called a fluoroscope to guide the needle.

Bone marrow biopsy. For patients with small cell lung cancer, doctors sometimes use a local anesthetic (to numb the area) and a special needle in order to remove a tiny piece of bone (typically from the hip bone) in order to determine whether small cell cancer is present within the bones.

Thoracentesis. After numbing the area, a needle is inserted through the chest wall and into the space between the lung and the wall of the chest where fluid can collect. The fluid is taken out and checked for cancer cells by the pathologist.

Thoracotomy. This procedure is performed in an operating room with the help of general anesthesia, which allows the person to "sleep" during this procedure. A surgeon then makes an incision in the chest, examines the lung directly, and takes tissue samples for testing. A thoracotomy is the procedure surgeons most often perform to completely remove a lung tumor.

Thoracoscopy. Through a small cut in the skin of the chest wall, a surgeon can insert a special instrument and a small video camera to assist in the examination of the inside of the chest. Patients require general anesthesia, but recovery time may be shorter given the smaller incisions. This procedure may be referred to as "VATS" (video-assisted thoracoscopic surgery).

Mediastinoscopy. A surgeon examines and takes a sample of the lymph glands in the center of the chest (underneath the breastbone) by making a small incision at the top of the breastbone. This procedure also requires general anesthesia and is done in an operating room.

Imaging tests

In addition to biopsies and surgical procedures, imaging scans are vital to the care of people with lung cancer. No test is perfect, and no scan can diagnose lung cancer. Only a biopsy can do that. Chest x-ray and scan results must be combined with a person's medical history, a physical examination, blood tests, and biopsy information to form a complete story about where the cancer began, and whether or where it has spread.

CT and magnetic resonance imaging (MRI) scans. These scans produce images that allow doctors to see the size and location of lung tumors and/or lung cancer metastases. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI scanning is imprecise when used to image a structure that is moving, like your lungs. For that reason, the MRI scan is rarely used to study the lungs themselves.

Scans are also available that use radioactive molecules, called tracers, injected into the blood to show where cancer is possibly located:

Positron emission tomography (PET) scan. In a PET scan, radioactive sugar molecules are injected into the body. Lung cancer cells absorb sugar more quickly than normal cells, so they light up on the PET scan. PET scans are often used to complement information gathered from CT scan, MRI, and physical examination. Specialists in nuclear medicine help your doctor interpret PET scans. Some cancerous lung tumors do not take up sugar faster than normal tissues.

Bone scan. A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient's vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears gray to the camera, and areas of injury, such as those caused by cancer, appear dark.

Bone scans and PET scans are often used in combination with information gathered from a CT scan, MRI, regular x-rays, and a physical examination.