胸腔镜肺减容术治疗重度肺气肿的临床研究

Study on video-assistudy thoracoscopic lung volume reduction surgery in 40 patients with severe emphysema

目的总结电视胸腔镜行肺减容术治疗不均质型重度肺气肿的临床经验和应用价值。方法回顾性分析40例不均质型重度肺气肿患者在胸腔镜辅助下施行肺减容术的临床资料,其中单侧33例,分期双侧7例。用内镜切割缝合器切除一侧肺容积为20%-30%,对比术前、术后和术后半年病人的活动能力和呼吸指标的变化。结果本组病人治愈好转率97.5%(39/40),死亡率2.5%(1/40),术后并发急性呼吸衰竭5例(5/40,12.5%),持续漏气>7d10例(10/40,25.0%)。应激性消化道溃疡出血2例(2/40,5.O%),39例于术后6-22d康复出院,1例因术后出现对侧张力性气胸、呼吸功能衰竭而临床死亡;出院前患者呼吸困难指数从Ⅲ-Ⅴ级转为0～Ⅱ级,术后半年的1s时间肺活量(FEV1)增加46.3%,肺总量(TLC)下降25.1%,残气量(RV)下降37.6%,PaO2增加14mmHg(22.6%),PaCO2下降11mmHg(23.4%),6min步行距离增加137%,与术前比较差异有统计学意义。结论选择不均质型重度肺气肿患者进行电视胸腔镜肺减容术能明显改善病人的主观症状和增加活动能力,疗效确切,微创,死亡率低,但远期效果有待观察。

Objective To summarize the clinical experience and value of lung volume reduction surgery （LVRS） with VATS on unsymmetrical severe emphysema. Methods Forty cases of unsymmetrical severe emphysema who underwent LVRS with VATS were analyzed retrospectively, including 33 cases of unilateral lung volume reductions and 7 cases of lateral lung volume reductions by stages. The lung volume was reduced by a decrease of 20% - 30% with Endo-GIA. The respiration and the activity of patients before operation, after operation and six months after operation were analyzed. Results 97.5% （39/40） of patients had healed and the mortality was 2.5% （1/40） , 5 cases combined acute respiration failure （12.5%）. Persistent airleak （over 7 days） occurred in 10 cases （25%） , and 2 cases combined stress ulcer（ 5.0% ） , 39 patients came over in 6-22 days after operation. One patient died of pneumothorax and respiration failure. The respiratory difficulty index decreased from Ⅲ- Ⅴ to 0-Ⅱ when leaving hospital. Six months later, FEV1 got a increase of 46.3% , PaO2 of 22.6% and 6-minute ambulation distance of 137%. TLC got a decrease of 25.1% , RV of 37.6% , and PaCO2 of 23.4% （P 〈 0.05 ）. Conclusion LVRS with VATS for unsymmetrical severe emphysema can improve patients＇ symptoms and activities. It is effective, mini-traumatic, with a low mortality. But the long-term efficacy is to be observed.