经内科胸腔镜行巨型肺大泡减容术的疗效及安全性研究  

Efficacy and safety of giant emphysematous bulla volume reduction via medical thoracoscope

作　　者：张华[1] 王蕾[1] 葛长胜 薛广伟[1] 卜宪聪[1] 张炜[1] 段存玲 刘宗涛 王梦瑶 蔡永登 许伟伟 高妍 Zhang Hua;Wang Lei;Ge Changsheng;Xue Guangwei;Bu Xiancong;Zhang Wei;Duan Cunling;Liu Zongtao;Wang Mengyao;Cai Yongdeng;Xu Weiwei;Gao Yan(Department of Respiratory and Critical Care Medicine,Ri Zhao Hospital of Traditional Chinese Medicine,Rizhao 276800,China)

机构地区：[1]日照市中医医院呼吸与危重症医学科,日照276800

出　　处：《中华医学杂志》2021年第30期2370-2374,共5页National Medical Journal of China

基　　金：山东省医药卫生科技发展计划(2019WS163)。

摘　　要：目的探讨经内科胸腔镜行巨型肺大泡(GEB)减容术疗效与安全性。方法采用前瞻性单臂研究,对2018年7月至2020年9月就诊于日照市中医医院、符合纳入标准的GEB患者,经内科胸腔镜进行GEB减容术治疗并随访,分析其疗效与安全性;其中,影像学评价采用自拟标准,据前后胸部CT对比分为:GEB消失或接近完全消失(GEB缩减≥90%);显著缩小(75%≤GEB缩减<90%);缩小(50%≤GEB缩减<75%);无变化:未达到缩小标准。结果纳入47例患者,年龄M(Q_(1),Q_(3))为63.0(55.0,67.0)岁,男性43例。出院前GEB消失或接近完全消失43例,显著缩小3例,缩小1例;呼吸困难程度明显改善(P<0.05);动脉血二氧化碳分压(PaCO_(2))由(48.2±8.4)mmHg(1 mmHg=0.133 kPa)降至(45.4±7.3)mmHg(P<0.05);6 min步行距离(6 MWT)由(245.6±162.4)m增至(283.5±152.2)m(P<0.05)。24例完成术后6个月随访,CT结果显示减容效果持续,其中3例患者术后残腔进一步缩小或闭合;呼吸困难程度、6MWT[(384.4±148.2)m]、PaCO_(2)[(42.7±6.6)mmHg]较出院前进一步改善(P<0.05),氧合指数[(356.86±61.21)mmHg]较术前[(295.20±67.16)mmHg]、出院前[(294.50±76.69)mmHg]明显改善(P<0.05);无围手术期死亡。结论经内科胸腔镜GEB减容术可消除或显著缩减影像学所示GEB容积,降低PaCO_(2),改善呼吸困难程度和运动耐力;术后6个月随访上述获益持续,并显著改善氧合指数。Objective To evaluate the efficacy and safety of giant emphysematous bulla(GEB)volume reduction via medical thoracoscope.Methods This was a prospective,single-arm study conducted between July 2018 and September 2020 in Ri Zhao Hospital of Traditional Chinese Medicine.Patients who met the inclusion criteria were treated with GEB volume reduction via medical thoracoscope and were followed up to evaluate the efficacy and safety of the technique.According to comparison of preoperative and postoperative chest CT results,the self-designed evaluation criteria of imaging efficacy were as follows:complete or nearly complete disappearance of GEB(GEB volume reduction≥90%),significant reduction of GEB(75%≤GEB volume reduction<90%),reduction of GEB(50%≤GEB volume reduction<75%)and no change(GEB volume reduction<50%).Results A total of 47 patients were included,among whom 43 were males,with an age M(Q_(1),Q_(3))of 63.0(55.0,67.0).The CT results showed complete or nearly complete disappearance of GEB in 43 patients,significant reduction of GEB in 3 patients and reduction of GEB in 1 patient before discharge.The degree of dyspnea improved significantly(P<0.05).Arterial partial pressure of carbon dioxide(PaCO_(2))decreased from(48.2±8.4)mmHg(1 mmHg=0.133 kPa)to(45.4±7.3)mmHg(P<0.05).The 6-minute walk test(6MWT)increased from(245.6±162.4)m to(283.5±152.2)m(P<0.05).Six-month postoperative follow-up was completed in 24 patients,and CT results showed that the efficacy of volume reduction was continuous compared with that before discharge.GEB was further reduced or even disappeared in 3 of the cases.Besides,the degree of dyspnea,6MWT(384.4±148.2)m and PaCO_(2)(42.7±6.6)mmHg were improved significantly(P<0.05).The oxygenation index(356.86±61.21)mmHg was significantly higher than that before surgery(295.20±67.16)mmHg and before discharge(294.50±76.69)mmHg(P<0.05).No perioperative deaths occurred.Conclusions GEB volume can be completely eliminated or significantly reduced by this innovative technique,while PaCO_(2),the deg

关 键 词：胸腔镜 巨型肺大泡 减容 

分 类 号：R655.3[医药卫生—外科学]