胸腔镜肺大疱切除治疗慢性阻塞性肺疾病临床观察

Efficacy of Video-assisted Thoracoscopic Pulmonary Bullectomy in Treatment of Chronic Obstructive Pulmonary Disease

目的探讨慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）患者应用胸腔镜行肺大疱切除术的疗效。方法2004年10月～2007年6月，对23例COPD行胸腔镜肺大疱切除术。均为CT诊断非均质性COPD合并肺大疱患者，术前第一秒用力呼气量占预计值百分比（FEV．％）55．6％±4．9％，残气量占肺总量比值（RV／TLC）49．4％±8．3％。双腔气管插管、静脉复合麻醉。选用10mm胸腔镜，肺大疱切除采用内镜切割缝合器（Endo—GIA）。结果手术时间（38．0±4．3）min，术中出血〈100ml。复张性肺水肿3例。术后漏气〉72h5例，最长12d。胸腔引流管留置时间（6．3±2．1）d，总胸液量150～400ml，术后住院时间（13．8±3．5）d。23例术后6个月FEV，％为61．8％±4．0％，RV／TLC36．6％±4．8％，较术前明显改善（q=6．979和10．519，P〈0．05）。未见气胸复发。结论对非均质性COPD并肺大疱患者应用胸腔镜肺大疱切除术能较好改善患者症状，并发症少，疗效满意。

Objective To investigate the efficacy of video-assisted thoracoscopic pulmonary bullectomy for chronic obstructive pulmonary disease （COPD）. Methods A total of 23 patients with COPD, who were diagnosed by CT scanning, were treated with pulmonary bullectomy using video-assisted thoracoscopy in our hospital from October 2004 to June 2007. Before the operation, their percent predicted forced expiratory volume in 1 second （FEV1 % ） was （55.6 ± 4.9）% , and the ratio of residual volume to total lung capacity （RV/TLC） was （49. 4 ± 8. 3 ）%. The patients received the surgery under intravenous anesthesia with double-lumen endobronchial intubation. Video-assisted thoracoscopy was used with a 10 mm lens, and Endo-GIA stapler was employed to resect pulmonary bulla. Results The mean operation time was （38.0 ± 4.3） minutes, and the blood loss was not more than 100 ml. Three of the cases developed inflated pulmonary edema, and 5 had prolonged air-leakage （72 hours at least, 12 days in one case）. Chest tube was withdrawn in （6.3 ± 2. 1 ） days, during which a total of 150 to 400 ml drainage fluid were collected. The mean postoperative hospital stay was （ 13. 8 ± 3. 5） days. FEV1% and RV/TLC were evaluated in 6 months, which was increased significantly [（61.8 ±4.0）% and （36.6±4.8）%, compared with preoperation q =6.979 and 10.519, P〈0.05]. No recurrence of pneumothorax was found in this series. Conclusion Video-assisted thoracoscopy is effective for patients with COPD complicated with pulmonary bulla, and results in few postoperative complications.