肺减容术治疗重度阻塞性肺气肿的临床研究  

Clinical investigation of lung volume reduction surgery in patients with severe obstructive emphysema

作　　者：赵光磊 张海 李季冬 陈建中 江涛[2] 秦桂耀[2] 

机构地区：[1]贵州省黔南州中医院胸外科,都匀558000 [2]中南京中医药大学泰州附属医院,225300

出　　处：《贵州医药》2009年第6期500-502,共3页Guizhou Medical Journal

基　　金：贵州省黔南州科技局重点资助项目[黔南科合2007008]

摘　　要：目的探讨肺减容手术治疗重度阻塞性肺气肿的临床应用价值。方法本组肺减容手术8例,胸腔镜或辅助小切口双侧肺减容术5例,标准后外侧切口单侧肺减容术3例。术前根据计算机体层摄影术(CT)和同位素肺通气肺灌注扫描选择肺气肿手术靶区,术中使用奈维垫片直线型切割缝合器和腔内切割器切除病变,防止肺泡漏。结果手术时间80～230min,平均135min;主要并发症有肺泡漏≥7d2例,心房颤动1例,术后胸腔内出血1例。3例手术结束即拔出气管内插管,2例带管回病房需要机械通气。随访2～48个月,8例均健在,术后患者呼吸困难指数上升为Ⅰ级1例,Ⅱ级4例,Ⅲ级3例。结论肺减容术能改善重度阻塞性肺气肿患者肺功能,缓解呼吸困难,提高运动能力,但远期效果确有待观察。Objective To summarize the clinical experience and value of lung volume reduction surgery （LVRS） in the patients with severe obstructive emphysema. Methods Total of 16 patients which performed LVRS for 8, LVRS via video-assisted mini-thoracotomy for 5, and unilateral LVRS for 3. The cases was selected incision depending on the ＂target＂ location of emphysema determined by computed tomography （CT） scan and differential Ventilation/perfusion lung scan before operation. During the operation, a linear stapling device which fitted with strip of neoveil pericardium to prevent air leakage was used to excise the most emphysematous portion of the lung. Results The duration of operation was 80-230 min （mean 135 min）. The most frequent complications were prolonged air leak over 7 days in 2 patients, atrium fibrillation in 1, intra-thoracic bleeding in 1 patient. 3 patients were extubated at the end of the operation, 2 required mechanisms Ventilation past-operatively. The patients were followed up from 2 to 48 months and 8 patients are still alive. The index of dyspnea increased to 1 grade was 1 patient, to 2 grades were 4 patients, and to 3 grades were 3 patients after operation. Conclusion LVRS can improve the pulmonary function, relieve dyspnea, and enhance exercise capacity in many patients with severe obstructive emphysema. But the long-term efficacy needs to be farther observed.

关 键 词：重度 阻塞性肺气肿 肺减容术 电视胸腔镜手术 

分 类 号：R563.3[医药卫生—呼吸系统]