经内科胸腔镜肺大疱减容术治疗慢性阻塞性肺疾病合并巨型肺大疱的疗效和安全性研究  

Efficacy and Safety of Medical Thoracoscopic Bulla Volume Reduction in the Treatment of Chronic Obstructive Pulmonary Disease Combined With Giant Emphysematous Bullae

作　　者：路慧 李振华 余耀华 李国燕 梁婷婷 张华 LU Hui;LI Zhenhua;YU Yaohua;LI Guoyan;LIANG Tingting;ZHANG Hua(Zhengzhou University,Zhengzhou 450000,China;Department of Respiratory and Critical Care Medicine,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学,郑州450000 [2]郑州大学附属郑州中心医院呼吸与危重症医学科,郑州450000

出　　处：《四川大学学报（医学版）》2024年第2期403-410,共8页Journal of Sichuan University(Medical Sciences)

基　　金：河南省医学科技攻关计划联合共建项目(No.LHGJ20220856)资助。

摘　　要：目的 探讨经内科胸腔镜肺大疱减容术治疗慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并巨型肺大疱(giant emphysematous bulla, GEB)的疗效和安全性。方法 选取2021年3月–2022年12月就诊于郑州大学附属郑州中心医院的66例COPD合并GEB患者作为研究对象,将患者分为内科胸腔镜组(采用经内科胸腔镜肺大疱减容术治疗)30例和外科胸腔镜组(采用电视辅助胸腔镜手术治疗)36例,所有患者在出院前、出院后3个月、6个月进行随访。比较两组手术前后肺功能、六分钟步行距离(6-minute walk distance, 6MWD)、圣乔治呼吸问卷(St.George's respiratory questionnaire, SGRQ)评分及术后并发症差异,评估手术时长、术后住院时长、手术和住院费用、术后24 h最大视觉模拟评分(visual analog scale, VAS)。结果 两组基线资料差异无统计学意义,具有可比性;内科胸腔镜组[(0.78±0.29) L vs.(1.02±0.31) L,P<0.001]和外科胸腔镜组术后6个月第一秒用力呼气容积(forced expiratory volume in 1 second, FEV1)较术前均有改善[(0.80±0.21) L vs.(1.03±0.23) L,P<0.001],两组6MWD、SGRQ评分于术后3个月和术后6个月也观察到一定程度的改善(与术前相比,P<0.05),且于术后随访期间两组患者上述指标的组间比较差异无统计学意义。两组患者手术时间差异无统计学意义,内科胸腔镜组术后住院时间[(7.3±2.6) d]、术后24 hVAS疼痛评分[3.0(2.0, 3.3)分]均低于外科胸腔镜组[(10.4±4.3) d,4.5(3.0, 5.0)分],差异有统计学意义(P<0.05),内科胸腔镜组手术花费和住院总花费低于外科胸腔镜组(P<0.05)。内科胸腔镜组的并发症发生率低于外科胸腔镜组(46.7%vs. 52.8%),但差异无统计学意义。结论 经内科胸腔镜肺大疱减容术能改善COPD合并GEB患者的肺功能、生活质量和运动耐力,减轻术后短期疼痛,缩短术后住院时间,具有创伤小、恢复快、花费少的优点,值得临床推广应用。Objective To explore the efficacy and safety of medical thoracoscopic bulla volume reduction for the treatment of chronic obstructive pulmonary disease(COPD)combined with giant emphysematous bullae(GEB).Methods A total of 66 patients with COPD combined with GEB were enrolled in the study.All the subjects received treatment at Zhengzhou Central Hospital affiliated with Zhengzhou University between March 2021 and December 2022.The subjects were divided into two groups,a medical thoracoscope group consisting of 30 cases treated with medical thoracoscopic bulla volume reduction and a surgical thoracoscope group consisting of 36 cases treated by video-assisted thoracoscopic surgery.All patients were followed up before discharge and 3 months and 6 months after discharge.The preoperative and postoperative levels of the pulmonary function,6-minute walk distance(6MWD),and St.George's Respiratory Questionnaire(SGRQ)scores and differences in postoperative complications were compared between the two groups.The operative duration,postoperative length-of-stay,and surgical costs and hospitalization bills,and the maximum visual analog scale(VAS)pain scores at 24 h after the procedure were assessed.Results The baseline data of the two groups were comparable,showing no statistically significant difference.The forced expiratory volume in 1 second(FEV1)6 months after the procedures improved in both the medical thoracoscopy group([0.78±0.29]L vs.[1.02±0.31]L,P<0.001)and the surgical thoracoscopy group([0.80±0.21]L vs.[1.03±0.23]L,P<0.001)compared to that before the procedures.Improvements to a certain degree in 6MWT and SGRQ scores were also observed in the two groups at 3 months and 6 months after the procedures(P<0.05).In addition,no statistically significant difference in these indexes was observed during the follow-up period of the patients in the two groups.There was no significant difference in operating time between the two groups.The medical thoracoscopy group had shorter postoperative length-of-stay([7.3±2.6]d)and 24-ho

关 键 词：慢性阻塞性肺疾病 巨型肺大疱 胸腔镜手术 肺减容术 

分 类 号：R563.9[医药卫生—呼吸系统]