单侧胸腔镜下肺减容术治疗老年性大疱型肺气肿  

Lung volume reduction surgery under unilateral thoracoscope for treatment of senile bullous emphysema

作　　者：苏永超[1] 田作春[1] 曹卫东[1] 李才[1] 黄永善[1] Yong-chao Su;Zuo-chun Tian;Wei-dong Chao;Cai Li;Yong-shan Huang(Department of Thoracic Surgery, the Third People's Hospital of Hainan Province,Sanya, Hainan 572000, China)

机构地区：[1]海南省第三人民医院心胸外科,海南三亚572000

出　　处：《中国现代医学杂志》2017年第16期95-98,共4页China Journal of Modern Medicine

摘　　要：目的探讨单侧胸腔镜下行肺减容术(LVRS)治疗老年性慢性阻塞性肺疾病(COPD)的方法及疗效。方法经严格掌控手术适应证,30例重度大疱型肺气肿的患者被纳入手术,术中应用腔镜用切割缝合器(Endo GIA)切除无功能肺组织,切除部分占肺容积的20%~30%。对比术前、术后3、6和12个月的肺功能、血气及6 min步行试验等监测指标。结果 30例患者无死亡病例,术后随访肺功能、血气指标改善,呼吸困难症状减轻,活动耐力不同程度增加。术后3、6和12个月比较第1秒用力呼气量(FEV1)、最大肺活量(FVC)、肺残气量(RV),差异有统计学意义,术后3个月血氧分压(PO_2)、6 min步行实验(6MWT)与术后12月比较差异有统计学意义。结论胸腔镜下行肺减容术对于大疱型肺气肿是一种有效的治疗方法,可改善患者术后活动能力,提高患者生活质量,近期手术效果明显,随着时间延长手术效果有减退趋势。Objective To discuss the method and efficacy of lung volume reduction surgery(LVRS)underunilateral thoracoscope as the treatment for senile bullous emphysema.Methods A total of30cases with severebullous emphysema were selected for surgery under rigorous surgical indications.Endoscopic cutter stapler(EndoGIA)was applied in the operation to remove the non-functioning lung tissue,which accounted for20%-30%of thetotal lung volume.Then,monitoring indexes including pulmonary function,blood gas analysis and6-min walkingtest were checked before operation,3,6and12months after surgery,and compared.Results No death occurredamong the30cases.Follow-up survey showed relief of dyspnea and improvement of pulmonary function and bloodgas indexes,and increase of activity tolerance in different degrees.Comparison of the levels of FEV1,FVC and RVin3rd,6th and12th months after surgery showed significant differences.PO2and6-min walking test3months aftersurgery were significantly different from those12months after surgery.Conclusions LVRS under unilateralthoracoscope is an effective treatment for bullous emphysema,which could significantly improve the patients'abilityof daily life and quality of life after surgery.The short-term efficacy is obvious after surgery.However,as the timepassing the efficacy is in a decreasing trend.

关 键 词：慢性阻塞性肺疾病 胸腔镜手术 肺减容 

分 类 号：R563.3[医药卫生—呼吸系统]