双侧肺减容术治疗慢性阻塞性肺病6例

Bilateral lung volume reduction surgery for 6 cases of chronic obstructive pulmonary disease

目的探讨双侧开胸同时行肺减容术（LVRS）治疗慢性阻塞性肺病（COPD）的方法及疗效。方法经积极术前准备，严格挑选适应证后，6例重度肺气肿的患者被采用正中开胸同时行双侧手术，应用牛心包垫片以及直线切割缝合器切除过度膨胀、没有功能的肺组织，切除部分占肺容积的20％～30％，用纤维蛋白胶处理漏气的肺断面。术后处理着重于重症监护，辅助呼吸，肺漏气，哮喘等方面。术前和术后6个月对比血气、总肺活量（TIE）、肺残气量（RV）、第1秒肺活量（FEVI）以及6分钟步行实验（6MW）等指标。结果6例患者术后无死亡，随访6个月呼吸困难不同程度的减轻，呼吸功能、血气指标均有改善。结论正中开胸同时行双侧肺减容术可以改善重度肺气肿的症状，同时应强调肺减容术的围手术期处理，对减少并发症至关重要。

Objective To investigate the methods and effects of bilateral lung volume reduction surgery （LVRS） with median incision for chronic obstructive pulmonary disease（COPD）. Methods After careful preoperative preparation and strictly selecting indications, 6 patients with severe COPD underwent resection of dysfunction pulmonary tissues by linear stapler with bovine pericardium strips. Totally we resected 20% - 30% of the volume of lungs. The medical fibrous protein glue was used in LVRS procedures to reduce air leaks along staple lines. The postoperative treatments emphasized on ICU, assisted respiration, asthma and air leaks. The blood gas, TLC, RV, FEV1 and 6MW were analyzed between preoperation and 6 months of postoperation. Results All the patients＇ symptoms of dyspnea relieved, and some pulmonary functions improved significantly, and no death occurred during perioperation. Conclusion LVRS by median incision is an effective treatment for COPD, meanwhile, the perioperative treatments are very important to reduce the complications of LVRS.