电视胸腔镜辅助小切口在肺容积减少术治疗重度慢性阻塞性肺气肿的临床疗效分析

Video- assisted thoracic small incision surgery clinical analysis of lung volume reduction in the treatment of severe chronic obstructive pulmonary emphysema

目的 评估电视胸腔镜辅助小切口在肺容积减少术治疗重度慢性阻塞性肺气肿（COPD）的临床疗效.方法 对28例COPD患者采用胸腔镜下辅助小切口行肺容积减少术,其中单侧20例,双侧同期8例.根据术前胸部CT确定的靶区位置,切除过度充气的肺组织.比较COPD患者术前及术后6个月的肺功能、血气分析指标和活动能力的变化.结果 28例患者均于术后6～33 d康复出院,术后2例并发急性呼吸衰竭,1例死亡.3例并发肺部感染,4例并发持续漏气（时间最长达25 d）.术后3个月呼吸困难指数从Ⅲ～Ⅳ级转为I～Ⅱ级,肺总量（TLC）及功能残气量（RV）较术前改善（P〈0.05）.第1秒用力呼气容积（FEV1）、PaO2、PaCO2和6 min步行距离等明显改善（P〈0.01）.结论 对重度COPD患者行电视胸腔镜辅助小切口肺容积减少术具有独特的优势,能显著改善其呼吸功能、缓解临床症状、改善生活质量,效果肯定,安全可靠,是一种有效的治疗方法,有良好的临床应用价值.

Objective To evaluate video - assisted thoracoscope assisted small incision reduction surgery for treatment of severe chronic obstructive pulmonary emphysema in lhng volume （COPD） of clinical efficacy. Methods from 2006 August to 2012 December in our hospital department of thoracic surgery for 28 cases of severe COPD patients with thoracoscope assisted small incision underwent lung volume reduction surgery,including 20 cases of unilateral,8 bilateralo VATS was dedicated endoscopic staplers （EndoGIA）. According to the target position to determine preoperative chest CT, resection of lung hyperinflationo The respiration and the activity of patients before operation, after operation and six months after operation were analyzed. Results 28 patients after 6 - 33d recovered after operation,2 cases complicated with acute respiratory failure, 1 cases died ;3 cases of pulmonary infection,4 cases with persistent airleak（ time of up to 25d） . After 3 months of the respiratory difficulty index from III - 1V level to I level II, total lung capacity （TLC） and functional residual capacity （RV） better than that before operation （ P 〈 0.05 ） ; forced expiratory volume in one second （ FEV1 ）, PaCO2 and 6rain walking distance significantly improved （ P 〈 0.01 ） o Conclusion for patients with severe COPD TV thoracoscope assisted small incision reduction surgery has unique advantages in the lung vol- ume, can significantly improve the respiratory function relieve clinical symptoms, improve the quality of life, definite effect, safe and reliable, It is an effective treatment method and provide a good clinical application value.