肺减容术治疗重度肺气肿的临床研究  

Clinical Investigation of Lung Volume Reduction Surgery in Patients with Severe Emphysema

作　　者：杨光海[1] 李劲松[1] 潘永成[1] 王建军[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）》2007年第6期824-826,共3页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

摘　　要：目的评估肺减容术对重度肺气肿患者的疗效及定量CT对术后肺功能的预测价值。方法87例重度肺气肿患者行肺减容手术,双侧66例,单侧21例。术前行胸部定量CT检查,计算其CT肺气肿比例(CTR),并以CTR=2.5为分界点进行分组,比较两组间肺功能改善情况。术前和术后3、6、12、18、24、36个月分别测量肺功能、6分钟步行距离(6-MWD)、呼吸困难指数,并对其结果进行比较分析。结果87例中手术死亡1例,余均痊愈出院;术后3、6、12、18、24、36个月的FEVl、6-MWD较术前有明显提高(P<0.05);临床症状明显改善,呼吸困难指数再分级,40例术前Ⅳ级中8例转为Ⅰ级,32例转为Ⅱ级;18例术前Ⅴ级中2例转为Ⅰ级,2例转为Ⅱ级,12例转为Ⅲ级,2例转为Ⅳ级;CTR≥2.5的患者FEV1的改善较CTR<2.5的患者更加明显(P<0.05)。结论肺减容术能改善重度肺气肿患者肺功能,缓解呼吸困难,提高运动能力。定量CT对术后肺功能的预测价值较高。Objective To evaluate the curative effectiveness of lung volume reduction surgery （LVRS） and to assess the usefulness of quantitative CT in predicting postoperative pulmonary function in patients with severe emphysema. Methods Eighty-seven patients with severe emphysema underwent LVRS： bilateral LVRS in 66 patients and unilateral in 21 patients. All the patients underwent chest quantitative CT scan to calculate the CT emphysema ratio （CTR）. The results of lung function testing, 6-min walk distance （6-MWD） and dyspnea score were analyzed before and at 3rd, 6th, 12th, 18th, 24th and 36th month after LVRS. Results The FEV1 and the 6-MWD were significantly increased after surgery （P〈0.05）. For dyspnea score, among 40 patients with a preoperative grade of Ⅳ, 8 patients were improved to grade Ⅰ , 32 to grade Ⅱ ; among 18 patients with a preoperative grade of V , 2 were improved to grade Ⅰ , 2 to grade Ⅱ , 12 to grade Ⅲ, and 2 to grade Ⅳ. The FEV1 for patients with CTR≥2.5 was increased significantly as compared with those with CTR〈2.5. Conclusion LVRS improves pulmonary function, decreases dyspnea, and enhances exercise capacity in many patients with severe emphysema. And quantitative CT can predict postoperative pulmonary function effectively.

关 键 词：肺减容手术 重度肺气肿 肺功能 定量CT 

分 类 号：R563.3[医药卫生—呼吸系统]