胸腔引流微管与胸腔镜治疗肺气肿合并巨大肺大疱的临床疗效比较

Comparison of clinical effect of thoracic drainage microtube and thoracoscopy in treatment of emphysema complicated with giant pulmonary bullae

目的胸腔引流微管与胸腔镜下肺减容术(LVRS)治疗肺气肿合并巨大肺大疱的临床疗效比较。方法选取肺气肿合并巨大肺大疱患者88例为研究对象,根据治疗方式分为微管组(49例)和LVRS组(39例)。比较2组患者手术时间、术中出血量和术后住院时间,术前、术后2周和术后2个月的肺功能[第1秒用力呼气末容积占预计值百分比(FEV1%预计值)和FEV1占用力肺活量百分比(FEV1/FVC)]、肺动脉压、动脉血氧分压[(p(O_(2))]、二氧化碳分压[p(CO_(2))]和血氧饱和度,评估术后呼吸困难指数和生活质量得分。结果与LVRS组相比,微管组手术时间缩短,术中出血量减少,术后住院时间缩短(P<0.01)。相比术前,2组患者术后2个月时FEV1%预计值、FEV1/FVC、p(O_(2))和血氧饱和度较术前升高,肺动脉压和p(CO_(2))较术前降低,且微管组上述指标较LVRS组明显改善(P<0.05)。2组术后动脉血氧饱和度比较差异无统计学意义(P>0.05)。术后2个月时,微管组呼吸困难指数Ⅲ~Ⅳ级比例较LVRS组下降,生活质量评分升高(P<0.05)。结论对于肺气肿合并巨大肺大疱的患者,胸腔引流微管的创伤更小,术后肺功能和血氧饱和度恢复更快,是一种较好的临床治疗方案。

Objective To compare the clinical efficacy of chest drainage microtubules and lung volume reduction surgery(LVRS)in the treatment of emphysema complicated with giant bullae.Methods A total of 88 patients with emphysema complicated with giant bullae were selected as subjects.Patients were divided into the microtubule group(49 cases)and the LVRS group(39 cases)according to the treatment method.The differences in operative time,blood loss and postoperative hospital stay were compared between the two groups.Pulmonary function[percentage of forced end-expiratory volume in 1 second to estimated value(FEV1%estimated value)and FEV1 to forced vital capacity(FEV1/FVC)],pulmonary artery pressure,arterial partial pressure of oxygen[p(O2)],partial pressure of carbon dioxide[p(CO2)]and oxygen saturation before surgery were recorded before surgery,2 weeks and 2 months after surgery.Postoperative dyspnea index and quality of life score were evaluated.Results Compared with the LVRS group,there were shorter operation time,less blood loss and shorter postoperative hospital stay in the microtubule group(P<0.01).Compared with before surgery,FEV1%predicted value,FEV1/FVC,p(O2)and blood oxygen saturation were increased 2 months after surgery in the two groups,while pulmonary artery pressure and p(CO2)were decreased,and the above indexes were significantly improved in the microtubule group compared with those of the LVRS group(P<0.05).There was no significant difference in postoperative arterial oxygen saturation between the two groups(P>0.05).Two months after operation,the proportion of dyspnea indexⅢtoⅣwas lower in the microtubule group than that in the LVRS group,and the quality of life score was higher in the microtubule group(P<0.05).Conclusion For patients with emphysema complicated with giant bullae,thoracic drainage microtubules have less trauma and faster recovery of lung function and blood oxygen after operation,which is a good clinical treatment.