同期肺减容术在肺、食管贲门疾病外科治疗中的临床应用

Clinical application of lung volume reduction surgery in treatment of severe emphysema combined with diseases of lung, esophagus and cardia

目的 探讨同期肺减容术 (LVRS)在治疗重度肺气肿合并肺、食管贲门疾病的手术方法及临床疗效。方法 9例肺气肿合并食管贲门癌患者行食管贲门癌切除同期一侧LVRS ,13例肺气肿合并肺部其它疾病者施行包括病变在内的LVRS。结果 所有患者均顺利渡过围手术期。呼吸困难症状改善 ,指数分级由Ⅲ级降低为Ⅱ级。肺功能和动脉血气明显改善 ,6min步行距离显著延长。结论 LVRS为部分重度肺气肿合并其它胸外科疾病患者提供了新的治疗方法 。

Objective To discuss the operative methods and the clinical effects of lung volume reduction surgery (LVRS) in the treatment of severe emphysema combined with diseases of lung, esophagus, and cardia. Methods Esophageal or cardiac carcinoma resection and gastroesophagectomy were performed in 9 cases followed by the same side LVRS. LVRS with the lesions was performed in 13 patients with pulmonary diseases. The pulmonary functions and dyspnea indices before and after operation were compared. Results All patients survived the perioperative stage safely. The symptoms of dyspnea of patients were improved from Ⅲ to Ⅱ. FEV 1, FEV 1/FVC, DLCO, RV, PaO 2, and PaCO 2 were significantly improved. Six minute walking distance (6MWD) was significantly increased. Conclusion LVRS might be a new operative method for some patients with severe emphysema combined with other thoracic surgical diseases, and might also provide conditions for patients to stably survive the perioperative period and for the improvement of postoperative pulmonary functions.