A 67-year-old man was referred for further evaluation of an abnormal chest roentgenogram. Computed tomography showed a 40 × 30 mm mass in the left upper lobe. A giant bulla occupying about two-thirds of the right...A 67-year-old man was referred for further evaluation of an abnormal chest roentgenogram. Computed tomography showed a 40 × 30 mm mass in the left upper lobe. A giant bulla occupying about two-thirds of the right thorax was found compressing the adjacent lung parenchyma, shifting the mediastinum to the left. The mass was a primary lung cancer, clinical T2aN0M0, stage IB. Preoperative respiratory function evaluation showed poor pulmonary function, with a forced expiratory volume in 1 second of 1070 ml (29.2% of predicted). Therefore, we first performed giant bullectomy by video-assisted thoracoscopic surgery. At 1 month after this operation, improvement of the forced expiratory volume in 1 second significantly to 2140 ml (80.1% of predicted) was observed. Therefore, we performed resection for the tumor. He was discharged after an uneventful postoperative course, and has remained in good condition for 6 months after the operation.展开更多
目的比较4种手术方法治疗重度慢性阻塞性肺疾病伴肺大疱的临床疗效。方法回顾性选取2019年1月—2021年12月广元市第一人民医院心胸外科79例重度慢性阻塞性肺疾病伴肺大疱手术患者,根据切口类型不同为开胸组(n=12)、小切口组(n=15)、单孔...目的比较4种手术方法治疗重度慢性阻塞性肺疾病伴肺大疱的临床疗效。方法回顾性选取2019年1月—2021年12月广元市第一人民医院心胸外科79例重度慢性阻塞性肺疾病伴肺大疱手术患者,根据切口类型不同为开胸组(n=12)、小切口组(n=15)、单孔组(n=23)、两孔组(n=29),4组患者均施行单侧肺减容、肺大疱切除术。统计患者一般资料、手术时间、术中出血量、重症加强护理病房(intensive care unit,ICU)时间、术后总引流量、胸管留置时间、住院时间、不良事件发生率、肺功能、血气指标、6 min步行距离并进行对比分析。结果79例患者无围术期死亡,术后2个月开胸组因严重的肺部感染合并呼吸衰竭死亡1例。4组患者手术时间、死亡发生率比较,差异无统计学意义(P>0.05)。单孔和两孔胸腔镜组术中出血量、ICU时间、术后总引流量、胸管留置时间、住院时间、不良事件发生率较小切口及开胸手术比较,差异有统计学意义(P<0.05)。4组患者术后7 d第1秒用力呼气容积占预计值百分比(63.55±25.15)、(61.69±24.53)、(64.02±24.22)、(64.20±30.09)较术前比较(44.48±12.55)、(42.01±13.15)、(43.89±13.21)、(42.59±14.76)均明显改善,差异有统计学意义(P<0.05)。结论单孔和两孔明显优于小切口及开胸手术,术后患者呼吸困难及生活质量明显改善。是一种创伤小、有效、可靠和安全的手术技术,可以让患者在几年内获得更好的生活质量,更适合肺功能差的患者。展开更多
文摘A 67-year-old man was referred for further evaluation of an abnormal chest roentgenogram. Computed tomography showed a 40 × 30 mm mass in the left upper lobe. A giant bulla occupying about two-thirds of the right thorax was found compressing the adjacent lung parenchyma, shifting the mediastinum to the left. The mass was a primary lung cancer, clinical T2aN0M0, stage IB. Preoperative respiratory function evaluation showed poor pulmonary function, with a forced expiratory volume in 1 second of 1070 ml (29.2% of predicted). Therefore, we first performed giant bullectomy by video-assisted thoracoscopic surgery. At 1 month after this operation, improvement of the forced expiratory volume in 1 second significantly to 2140 ml (80.1% of predicted) was observed. Therefore, we performed resection for the tumor. He was discharged after an uneventful postoperative course, and has remained in good condition for 6 months after the operation.
文摘目的比较4种手术方法治疗重度慢性阻塞性肺疾病伴肺大疱的临床疗效。方法回顾性选取2019年1月—2021年12月广元市第一人民医院心胸外科79例重度慢性阻塞性肺疾病伴肺大疱手术患者,根据切口类型不同为开胸组(n=12)、小切口组(n=15)、单孔组(n=23)、两孔组(n=29),4组患者均施行单侧肺减容、肺大疱切除术。统计患者一般资料、手术时间、术中出血量、重症加强护理病房(intensive care unit,ICU)时间、术后总引流量、胸管留置时间、住院时间、不良事件发生率、肺功能、血气指标、6 min步行距离并进行对比分析。结果79例患者无围术期死亡,术后2个月开胸组因严重的肺部感染合并呼吸衰竭死亡1例。4组患者手术时间、死亡发生率比较,差异无统计学意义(P>0.05)。单孔和两孔胸腔镜组术中出血量、ICU时间、术后总引流量、胸管留置时间、住院时间、不良事件发生率较小切口及开胸手术比较,差异有统计学意义(P<0.05)。4组患者术后7 d第1秒用力呼气容积占预计值百分比(63.55±25.15)、(61.69±24.53)、(64.02±24.22)、(64.20±30.09)较术前比较(44.48±12.55)、(42.01±13.15)、(43.89±13.21)、(42.59±14.76)均明显改善,差异有统计学意义(P<0.05)。结论单孔和两孔明显优于小切口及开胸手术,术后患者呼吸困难及生活质量明显改善。是一种创伤小、有效、可靠和安全的手术技术,可以让患者在几年内获得更好的生活质量,更适合肺功能差的患者。
