单侧肺减容术治疗晚期慢性阻塞性肺疾病的临床疗效观察  

Clinical Outcome of Unilateral Lung Volume Reduction Surgery on Patients with Chronic Obstructive Pulmonary Disease of End-stage

作　　者：王家顺[1] 王胜[1] 王建军[1] 丁静民[1] 翟伟[1] 邓小乐[1] 李劲松[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院胸外科,武汉430022

出　　处：《华中科技大学学报（医学版）》2006年第3期377-379,共3页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：湖北省科技攻关计划资助项目(No.2002AA304B14)

摘　　要：目的 评价单侧肺减容术（LVRS）治疗慢性阻塞性肺疾病（COPD）的疗效、手术适应证，总结手术操作要点。方法 分析1999年9月～2003年9月间协和医院胸外科进行单侧LVRS的14例COPD患者资料。术前利用CT平扫、CT三维重建和核素肺通气灌注成像确定“靶区”。14例患者中5例行标准后外侧切口手术，9例行胸腔镜或胸腔镜辅助小切口手术；使用直线切割缝合器TLC-75或胸腔镜专用切缝器（Endo-GIA）切除过度充气破坏的肺组织。比较术前、术后1年、术后2年的呼吸困难程度及肺功能和6分钟步行距离的变化，以评价单侧LVRS的临床疗效。结果 单侧LVRS后一秒钟用力呼气容积（FEV1）平均提高（38±7）％；6分钟步行距离（6MWD）平均提高（70±25）％；呼吸困难指数再分级：8例术前Ⅲ级中7例转为Ⅰ级，1例转为Ⅱ级；6例术前Ⅳ级中3例转为Ⅱ级，2例转为Ⅲ级，1例转为Ⅰ级。本组1年、2年生存率分别为100％、92．8％，无手术中死亡，术后并发症发生率为35．7％。结论 单侧LVRS可以改善具备手术指征的COPD患者的临床症状和肺功能，且围手术期死亡率及手术并发症发生率低。尽量切除术侧无功能肺组织，防止肺漏气为手术要点。Objective To evaluate the effectiveness of unilateral lung volume reduction surgery （LVRS） in the treatment of the patients with severe chronic obstructive pulmonary disease （COPD）. Methods The follow-up data of 14 patients with COPD who had undergone unilateral LVRS between September 1999 to September 2003 were analyzed. The operative target was determined by preoperative CT and pulmonary ventilation perfusion （V/Q） scintigraphy. LVRS was performed in 9 patients through video assisted thoracoscopy surgery （VATS）. In 5 patients LVRS was performed through posterolateral thora cotomy. Destroyed pulmonary tissue was resected by liner stapler （TLC-75） or Endo-GIA. To evaluate the effectiveness of uni lateral LVRS, the changes in dyspnea score, pulmonary function quality of life and 6-min walking distance （6MWD） were analyzed. Results The postoperative follow up interval range was 2 years. The mean FEV1 was increased by （38 ± 7） 0%, and 6MWD increased by （70±25）%. For dyspnea score, among 8 patients with a preoperative grade of Ⅲ, 7 were converted to grade Ⅰ , 1 to grade Ⅱ ; among 6 patients with a preoperative grade of IV, 3 were converted to grade 11 , 2 to grade Ⅲ, and 1 to grade Ⅰ .One- and 2-year survival rate was 100% and 92.8% respectively. There was no perioperative death in this group and the total postperativoe morbidity was 35.7%. Conclusion Unilateral LVRS shows significant clinical benefits for the selected patients with severe COPD and had lower perioperative mortality and morbidity. The key points of LVRS are to resect dysfunctional lung tissue as much as possible and to prevent pulmonary air leak.

关 键 词：肺气肿 单侧肺减容术 

分 类 号：R655.1[医药卫生—外科学]