慢性阻塞性肺疾病伴肺大疱患者的微创外科治疗

Mini-invasive Sugery for cases with chronic obstructive pulmonary disease and bullae of lung

目的探讨微创外科治疗慢性阻塞性肺疾病（COPD）伴肺大疱的效果。方法对2001年10月至2009年6月收治的72例COPD伴肺大疱患者行胸腔镜肺大疱切除术,其中COPD伴肺大疱患者52例,伴气胸者20例;若胸腔内粘连尚可分离、肺大疱呈非弥漫性分布,予完全胸腔镜下肺大疱切除;若胸腔镜探查发现胸腔内广泛粘连、肺大疱太多或呈弥漫分布,则采用胸腔镜加小切口肺大疱切除术;并对手术前后患者肺功能进行对比分析。结果完全胸腔镜手术36例次,行胸腔镜＋小切口手术46例次（双侧肺大疱患者10例行分期手术）。手术时间30~240 m in,住院时间10~72 d。术后随访64例2~72个月,患者胸闷、气促等症状明显改善,术前气胸者无气胸复发;术后3、6个月肺功能均较术前明显提高（P〈0.05）。结论微创外科治疗COPD伴肺大疱疗效显著。手术指征、手术方法以及术后管理对治疗效果起决定作用。

Objective To explore the effect of mini-invasive sugery for cases with chronic obstructive pulmonary disease（COPD）and bullae of lung and to summarize the surgical treatment experience.Methods From October 2001 to June 2009,mini-invasive sugery was performed on 72 patients suffering from COPD and bullae of lung,among which,20 patients accompanied with pneumatothorax.The bullae resection was complete visual-assisted thoracic surgery（VATS）if there was only a few non-dispersible bullaes and the adhesion could be separated in thoracic cavity.Little incision was added when there was a large number of bullaes and the bullaes were in disseminated distribution,or it was difficult to separated the adhesion in thoracic cavity.Contrast and analysis of the pulmonary function test were performed before and after the operation.Results Complete VATS bullae resection was performed on 36 cases,28 of which didn′t accompanied with pneumatothorax,and little incision was added in 46 cases（two-stage operation was adopted on 10 cases with bilateral lung bullae）.The operative time was 30~240 min,duration of drainage was 3~35 days and the hospital stay was 10~72 days.Clinical symptoms such as dyspnea and tachypnea remarkably improved and no recurring pneumothorax occued in 64 cases after being followed up for 2~72 months.They showed a significantly clinical improvement in pulmonary function test after the operations 3 and 6 months.Conclution The outcome of VATS bullae resection is inspiring for patients with COPD and bullae of lung.The therapeutic results are determined by the control of operative indications and surgical approaches and postoperative management.