肺减容术治疗自发性气胸及肺气肿

Lung volume reduction surgery of treatment of spontaneous pneumothorax combined chronic obstructive emphysema

目的探讨肺减容术治疗自发性气胸合并慢性阻塞性肺气肿的可行性和临床疗效.方法10例自发性气胸合并慢性阻塞性肺气肿患者行单侧肺减容术,手术采用中国常州XF90或XF60直线切割缝合器,并衬以自体胸膜肺组织片,切除因过度膨胀而破坏的、无功能肺组织,切除一侧肺容量的20%～30%.结果术后呼吸困难明显减轻,90%患者呼吸困难指数从3,4级转为1,2级.肺功能1秒时间肺活量(FEV1)明显增加,残气量(RV)和肺总量(TLC)明显下降.动脉血氧分压平均上升14.5mmHg.6min步行试验亦明显增加.上述指标术后与术前比差异均有显著意义(P＜0.01).本组无围手术期死亡.结论肺减容术治疗自发性气胸合并肺气肿能改善患者肺功能和生活质量,是一种新技术和有效治疗方法.

Objective: To investigate the feasibility and clinical effects of lung volume reduction surgery (LVRS) for the treatment of spontaneous pneumothorax combined chronic obstructive emphysema. Methods: 10 patients with spontaneous pneumothorax combined chronic obstructive emphysema underwent resection of the targeted overinflated, destructive and dysfunction pulmonary tissue by linear stapler XF90 or XF60 with pleura-lung tissue of one′s own made in Changzhou of China. 20%~30% of the volume of each lung was resected. Results: After operation, dyspnea evidently alleviated. And dyspnea index of 90% patients were changed from 3, 4 grade to 1, 2 grade. Pulmonary funtion FEV1, MVV, and PaO2 increased evidently, RV and TLC reduced evidently, six-minute walk test increased too. There was significan difference above indexes between preoperation and postoperation (P <0.01). No death occurred during preoperation. Conclusions: LVRS can improve the respiratory function and quality of life for patients with spontaneous pneumothorax combied chronic obstructive emphysema, and LVRS is an effective treatment and new techniques to them.