经支气管镜内活瓣植入肺减容术的常见并发症及其影响

Common Complications and Their Influence of Lung Volume Reduction Surgery by Transbronchoscopic Valve Implantation

目的探讨内镜下支气管内活瓣(EBV)植入肺减容术的常见并发症及其影响。方法回顾性分析我院2011年6月至2015年6月采用EBV植入肺减容术的11例患者的临床资料,对其术后并发症情况、住院天数及医疗支出情况进行统计。结果术后3个月并发症发生情况:慢阻肺急性加重(1/11),气胸(4/11),活瓣移位(2/11);术后12个月并发症情况:慢阻肺急性加重(3/7),气胸(1/7),咯血(1/7),肉芽肿形成(3/7);发生气胸患者较未发生气胸患者住院天数延长,差异有统计学意义(20.3d vs.9.0d,P<0.01),医疗支出增加,差异有统计学意义(14554.7元vs.6043.9元,P<0.01)。结论 EBV植入肺减容术并发症是客观存在的,短期并发症以气胸和活瓣移位最为常见,长期并发症以肉芽组织形成多见,术后密切观察患者并发症情况,一旦发生并发症规范、积极处理尤为关键。

Objective To investigate the complications and their influence of lung volume reduction surgery（ LVRS） by endoscopic endobronchial valve（ EBV） implantation. Methods Clinical data of 11 patients received LVRS by EBV implantation between June 2011 and June 2015 in our hospital were retrospectively analyzed and the postoperative complications,hospitalization days and medical expenses were collected and analyzed. Results Complications occurred within 3 months after operation： acute exacerbation chronic obstructive pulmonary disease（AECOPD）（1/11）,pneumothorax（4/11）and shift valve（2/11）. Complications occurred within 12 months after operation：AECOPD（3/7）,pneumothorax（1/7）,hemoptysis（1/7）and granuloma formation （3/7）. Patients occurred pneumothorax had longer length of hospital stay（20. 3d vs. 9. 0d,P〈0. 01）and more medical expenditure（ ￥ 14554. 7 vs. ￥ 6043. 9,P〈0. 01）than patients with no occurrence of pneumothorax. Conclusion Complications of LVRS byEBV implantation exists objectively. Pneumothorax and valve shift are the most common short-term complications and granulation tissue formation is the most seen long-term complication. Patients should receive close postoperative observation for complications. Active and standard treatment is extremely critical once complications occurs.