肺减容手术治疗重度阻塞性肺气肿  

Lung volume reduction surgery for treatment of severe chronic obstructive emphysema

作　　者：姚珂[1] 张国强[1] 向明章[1] 闵家新[1] 周人杰[1] 邹利光[2] 

机构地区：[1]重庆第三军医大学新桥医院胸外科,400037 [2]重庆第三军医大学新桥医院放射核医学科,400037

出　　处：《心肺血管病杂志》2003年第1期28-30,共3页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的 :为了提高肺气肿患者的生存质量 ,探讨肺减容手术治疗重度慢性阻塞性肺气肿的可行性及预后。方法 :本组肺减容手术 6例 ,其中同期双侧肺减容手术 2例 ,分期双侧肺减容手术 1例 ,标准后外侧切口单侧肺减容手术 3例。术前根据计算机断层摄影术 (CT)和同位素肺通气灌注扫描选择肺气肿手术“靶区” ,术中使用带牛心包垫的直线切割缝合器切除病变 ,防止肺泡漏气。结果 :手术时间 110～ 2 6 0min ,平均 16 6min ;术后主要并发症有肺持续漏气≥ 7d 4例 ,呼吸衰竭 1例 ,心房颤动 1例 ,肺部感染 1例。 4例手术结束即拔除气管内插管 ,2例带管回病房需要机械通气。随访 2～ 4 3个月 ,4例健在 ,术后患者呼吸困难指数上升为Ⅰ级 1例 ,Ⅱ级 2例 ,Ⅲ级 1例。结论 :慢性阻塞性肺气肿病人选择性手术能改善患者肺功能 ,提高生存质量 。Objective:To evaluate the feasibility of lung volume reducation surgery (LVRS) the treatment of severe chronic obstructive emphysema.Method:To perform LVRS for 6 patients,of which,simultaneously bilateral LVRS for 2,bilateral LVRS by stages in 1 and unilateral LVRS in 3.The selection of incision depending on the “target” location of emphysema,detrmined by computed tomography scan and differential ventilation/perfusion lung scan.A linear stapling device,which fitted with strips of bovine pericardium to prevent air leakage,was used to excise the most emphysematous portion of the lung.Result:The duration of operation was 110～260 min(mean 166 min).The most frequent complications were prolonged air leak over 7 days in 4 patients,respiratory failure in 1,atrial fibrillation in 1 and pneumonia in 1.Four patients were extubated at the end of operation,two patients required mechanic ventilation postoperatively.Follow up 2～43 months,4 patients are still alive,but the dyspnea scale increased:1 grade in 1,2 grades in 2 and 3 grades in 1.Conclusion:LVRS can improve the respiratory funtion and quality of life for selected patients with emphysema,but the long\|term results is not clear now.

关 键 词：肺减容手术 重度阻塞性肺气肿 手术治疗 生存质量 临床资料 

分 类 号：R655.3[医药卫生—外科学]