肺减容术治疗重度肺气肿的临床研究

Study on lung volume reduction surgery in 78 patients with severe emphysema

目的总结肺减容术（LVRS）治疗不均质型重度肺气肿的临床经验及提高远期疗效的措施。方法回顾性分析施行LVRS的78例不均质型重度肺气肿患者临床资料，其中单侧52例，分期双侧17例，同期双侧9例。用切割缝合器切除一侧肺容积为20％～30％，对比术前、术后出院前1天、术后半年、1年和2年患者的活动能力和肺功能指标的变化。结果好转71例，加重2例，死亡5例。术后并发呼吸衰竭8例，持续漏气〉7d14例，73例于术后8～54d康复出院，5例死于呼吸衰竭。术后患者的FEV，等6项指标改善，术后2年患者各项指标较术后半年和术后1年有下降趋势，但差异无统计学意义。结论LVRS能明显改善不均质型重度肺气肿患者的主观症状，增加活动能力，近期疗效确切，但2年后肺功能有减退趋势，远期效果有待进一步观察和提高。

Objectives To summarize the clinical experience of lung volume reduction surgery（LVRS） in patients with unsymmetrical severe emphysema. Methods 78 patients with unsymmetrical severe emphysema with LVRS were retrospectively analyzed. The patients were including unilateral LVRS （52 cases）, bilateral LVRS at different stage （17 cases） and bilateral LVRS at the same stage （9 cases）. The lung volume was reduced with GIA by a degree of 20% 30%. The activity and the lung function indexes of patients before LVRS, 1 day before leaving hospital, half a year, 1 year and 2 years after LVRS were analyzed. Results 91.03% （71/78） of patients were healed, 2.56% （2/78） of patients worsened and 6.41%（5/78） of patients died of respiration failure. 73 eases of patients recovered and were discharged in 8-54 days after LVRS. The forced expiratory volume in one second （FEV1）, total lung capacity （TLC）, residual volume （RV）, partial pressure of oxygen （PaO2）, partial pressure of carbon dioxide （PaCOz） and 6-minute ambulation distance （6MWT） of patients with LVRS were significantly improved after operation （P〈0.05）. The improvement of these indexes reached the peak 1 year after LVRS, and decreased 2 years after LVRS. Conclusions LVRS could significantly improve patients with unsymmetrical severe emphysema subjective symptoms and increase activity. The short-term effect was precise, but the lung function began to decrease 2 years after LVRS.