肺减容手术治疗重度慢性阻塞性肺疾病的临床观察

Effects of lung-volume reduction surgery for treatment of severe chronic obstructive pulmonary disease

目的观察肺减容手术治疗重度慢性阻塞性肺疾病（COPD）的指征、疗效及其术后并发症等。方法57例重度COPD病人行肺减容手术，术前及术后6个月测肺功能、动脉血气及6分钟步行距离（6MWD），对其结果进行分析。结果57例重度COPD患者接受肺减容术，切除一侧肺组织的20％～30％。术后3例死亡，1例病情加重，其余病人临床症状改善，呼吸困难减轻，活动能力增强，术后6个月第1秒用力呼气容积（FEV1）及6MWD较术前分别提高31．9％和53．1％（P〈0．05），残气容积（RV）、肺总量（TLC）较术前分别降低30．8％和27．3％（P〈0．05），Pa02较术前提高23．1％（P〈0．05），PaCOz由术前平均45．86mmHg变为术后平均46．28mmHg，无明显变化（P〉0．05）。结论重度COPD患者行肺减容手术可取得较好的近期治疗效果，疗效与手术指征的掌握有一定的关系。

Objective To investigate the criteria for patient selection and the postoperative complications of lung volume reduction surgery（LVRS） in severe chronic obstructive pulmonary disease（COPD） and to observe the effects of LVRS. Methods 57 patients with severe COPD were underwent LVRS. The results of lung function,arterial blood gas analysis and 6-min walk distance（6MWD） were analyzed before and 6 month after LVRS.Results 57 patients with severe COPD were underwent LVRS, with a goal of resecting 20% to 30% of each lung.3 patients died and l patient got worse after the operation. The other patients got better and had better exercise capacity. FEV1, TLC, RV, PaO2 and 6MWD of the other patients were improved significantly in 6 month after LVRS （ all P 〈 0.05 ）, but there was no statistic difference in PaCO2. Conclusions Lungvolume reduction surgery can result in short-term benefits,with a goal of resecting 20% to 30% of each lung. The effects of LVRS is connected with the criteria of LVRS.