小切口结扎式单肺减容术治疗慢性阻塞性肺疾病

Lateral Lung Volume Reduction with Small Incision and Ligation for COPD:Report of 36 Cases

目的探讨小切口结扎式单肺减容过度气肿肺组织治疗重度慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)的疗效。方法1999年4月~2006年5月,小切口结扎式切割36例重度COPD过度气肿肺组织。结果术后6例肺漏气,经治疗后漏气消失,时间180min^5d,平均1.6d;无围手术期死亡。术后1年复查,第1秒用力呼气量(FEV1)显著高于术前[(839.9±76.0)ml vs(589.0±80.5)ml,t=18.451,P=0.000];肺总量(TLC)显著低于术前[(5167.6±639.9)ml vs(6725.8±976.6)ml,t=8.116,P=0.000];残气量(RV)显著低于术前[(3062.4±722.0)ml vs(4329.6±669.9)ml,t=7.720,P=0.000];动脉血氧分压(PaO2)显著高于术前[(72±10)mm Hg vs(62±8)mm Hg,t=4.686,P=0.000];6分钟最长步行距离(6MWT)显著长于术前[(306.0±24.8)m vs(223.8±36.7)m,t=11.135,P=0.000]。结论小切口结扎式切割过度气肿肺组织术后可以明显改善具有手术适应证COPD患者的症状和生理状态。

Objective To investigate the efficacy of lateral lung volume reduction with small incision and ligation for the treatment of serious chronic obstructive pulmonary disease （COPD）. Methods From April 1994 to May 2006, 36 patients suffering from serious COPD complicated with severe emphysema underwent lateral lung volume reduction in our hospital. Small incision and ligation were used during the operation. Results After the surgery, 6 patients developed pulmonary air-leak, and were cured after 180-minute to 5-day treatments （ mean, 1.6 days）. No perioperative death in this series. One year after the operation, the patient had significantly higher FEVl and PaO2, and lower TLC and RV than those determined preoperation [ （ 839.9 ± 76.0 ） ml vs （ 589.0 ± 80.5） ml, t=18.451; （72±10） mm Hg vs （62±8） mm Hg, t =4.686; （5167.6 ±639.9） ml vs （6725.8 ±976.6） ml, t = 8. 116; （3062.4 ±722.0） ml vs （4329.6 ±669.9） ml, t =7.720; all P =0.000]. In addition, they had significantly longer 6MWT than that before the operation [ （306.0 ±24.8） mvs （223.8 ±36.7） m, t = 11. 135, P =0. 000]. Condusion For the patients with COPD who had indications for lateral lung volume deduction, resection of emphysemic tissues by the procedure using small incision and ligation can improve their symptoms and physiological conditions.