胸腔镜手术对慢性阻塞性肺病伴肺大疱患者的治疗研究

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

目的探讨胸腔镜手术对慢性阻塞性肺病(COPD)伴肺大疱的治疗效果。方法 2007年10月—2010年6月我科收治的52例COPD伴肺大疱患者行胸腔镜下肺大疱切除术,其中伴气胸者10例;若胸腔内粘连尚可分离、肺大疱呈局限性非均质性分布,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、肺大疱太多或弥漫分布以及麻醉难以实现单肺通气,则采用胸腔镜加小切口肺大疱切除术;并对手术前后患者的肺功能进行对比分析。结果术后随访44例3～36个月,患者胸闷伴轻度呼吸困难等症状明显改善,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改善(P<0.05)。结论胸腔镜手术治疗COPD伴肺大疱疗效明显。手术指征、手术方法、围术期的策略以及管理对治疗效果起决定作用。

Objective To investigate the efficacy of video-assisted thoracoscopic pulmonary bullectomy for chronic obstructive pulmonary disease（COPD）.Methods A total of 52 patients with COPD,who were diagnosed by CT scanning,were treated with pulmonary bullectomy using video-assisted thoracoscopy in our hospital from October 2007 to June 2010,among which,10 patients accompanied with pneumathorax.The bullae resction was complete visual-assisted thoracic surgery if there was only a few bullaes lack of homogeneity 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 distribution with homogeneity.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 Clinical symptoms such as chest distress and tachypnea remarkable improved and no recurring pneumothorax occurred in 44 cases after being followed up for 3～36 months.They showed a significantly clinical improvement in pulmonary function test after the operations 3 and 6 months.Conclusion Video-assisted thoracoscopy is obviously effective for patients with COPD complicated with pulmonary bulla,The therapeutic results are determined by the control of operative indication and surgical approaches and perioperative period management.