19例军事飞行员肺大泡治疗及随访情况分析

Treatment and follow-up of 19 military pilots with pulmonary bullae

目的分析总结军事飞行员肺大泡的治疗及随访观察情况,为军事飞行员肺大泡的治疗策略的制定及随访管理规范提供参考依据。方法收集2010—2020年空军特色医学中心住院的19例军事飞行人员肺大泡的病例资料,根据是否行手术治疗分为手术组7例与非手术组12例,分析总结2组临床及影像学特点、治疗、随访及飞行鉴定情况。结果手术组与非手术组年龄、飞行时间、BMI、吸烟占比、自发性气胸占比差异无统计学意义(P>0.05),症状;手术组肺大泡平均直径及直径>1 cm占比均高于非手术组(P<0.05),2组肺大泡胸膜下占比、多发占比、双侧占比及上肺占比差异无统计学意义(P>0.05)。手术组术后飞行鉴定6例合格,1例因抑郁症不合格;非手术组飞行鉴定3例合格,9例双座合格,手术组飞行合格占比高于非手术组(P<0.05);手术组随访时间2~26个月,术后飞行时间20~470 h,非手术组随访时间3~86个月,随访飞行时间30~800 h,所有患者随访期间无自发性气胸发生,复查肺CT肺大泡均无显著变化。结论军事飞行人员肺大泡手术指征、规范随访及飞行鉴定需根据个体情况、飞行机种、肺大泡的影像学特点等综合考虑。

Objective To analyze the outcomes of treatment and follow-up of pulmonary bullae in military pilots.Methods Nineteen cases of pulmonary bullae in military pilots hospitalized in Air Force Medical Center between 2010 and 2020 were collected and divided into the surgical group(7 cases)and the non-surgical group(12 cases).The clinical and imaging characteristics,results of treatment and follow-up,and flight qualification of the two groups were analyzed.Results There was no significant difference in age,years of flight,BMI,the percentage of smokers or spontaneous pneumothorax between the two groups(P>0.05).There were more cases whose average diameter of pulmonary bullae was above 1 cm in the surgical group than in the non-surgical group(P<0.05).There was also no difference in the proportions of bullae in the upper lung,subpleural,bilateral and multiple bullae between the two groups(P>0.05).In the surgical group,6 cases were granted qualification for flight after operation,and 1 case was disqualified due to depression.3 cases in the nonsurgical group were granted qualification and 9 cases were granted qualification for double-seat flight.The proportion of flight qualification in the surgical group was higher than in the non-surgical group(P<0.05).The follow-up of the surgical group lasted 2-26 months,and the flight time after operation was 20-470 h,compared with 3-86 h and 30-800 h in the nonsurgical group after the detection of pulmonary bullae.There was no spontaneous pneumothorax or significant change in lung bullae in CT scan in either group during the follow-up.Conclusion The surgical indications,standard follow up and flight qualification of military pilots with pulmonary bullae should be considered in conjunction with the individual feature,types of aircraft and imaging characteristics of chest CT.