同期肺减容术对肺、食管恶性肿瘤手术治疗患者肺功能及运动能力的影响(英文)  

Effects of homochronous lung volume reduction surgery on pulmonary functions and exercise capability of patients with pulmonary or esophageal malignant tumor

作　　者：谭群友[1] 王如文[1] 蒋耀光[1] 龚太乾[1] 

机构地区：[1]解放军第三军医大学大坪医院野战外科研究所全军胸外科中心,重庆市400042

出　　处：《中国临床康复》2004年第11期2176-2177,共2页Chinese Journal of Clinical Rehabilitation

基　　金：重庆市科技攻关项目(20033301);解放军第三军医大学科研基金(20010307)资助~~

摘　　要：背景:肺、食管贲门疾病尤其是恶性肿瘤病例,常常需外科治疗,但合并重度肺气肿的患者由于肺功能较差常常失去手术机会。肺减容术(lungvolumereductionsurgery,LVRS)是治疗重度肺气肿的有效方法。目前尚缺乏有关将两种手术方式结合以增加上述病例外科治疗机会的系统研究。目的:评价肺、食管贲门疾病外科治疗的同时行同侧LVRS后患者的肺功能变化及其对患者运动能力的影响。设计:采用自身手术前后对照的临床研究方法。地点和对象:资料收集于第三军医大学大坪医院胸外科中心。对26例重度肺气肿合并肺、食管贲门疾病患者进行手术和肺功能检测。干预措施:11例重度肺气肿合并食管贲门癌患者行食管贲门癌切除、食管胃胸腔内吻合的同时,将小牛心包片缝垫于美国强生公司产TLC75直线形切割缝合器的两个钉合面,根据术前影像学检查及术中所见并结合胸腔胃的大小,切除边缘部过度气肿的肺组织,切除部分大约为单侧肺容积的25%～30%;9例肺气肿合并肺癌者施行肺叶切除术;6例肺气肿合并肺部其他良性疾病者施行包括病变在内的肺楔形切除术。若有漏气,则喷注医用生物蛋白胶。比较术前、术后的肺功能。主要观察指标:手术前后下列指标的变化情况:呼吸困难指数、第一秒用力呼气容积(forcedexpiratoryvolumewithin1second,FEV1)。BACKGROUND:Surgical procedures are often necessary in removing the lesions in esophageal or pulmonary diseases, particularly malignant tumors.Unfortunately, b ecause of poor pulmonary function, some patients combined with severe emphysema often lose the opportunities to receive surgical treatment. Lung volume reductio n surgery(LVRS) is an effective operation for severe emphysema. However, little systemic research has been conducted on the combination of the two surgical proc edures to increase opportunities of surgical treatment.OBJECTIVE:To evaluate the effects of homochronous LVRS on pulmonary function a nd exercise capacity of the patients after receiving pulmonary or esophageal res ection. DESIGN:Pre- and post-operative self-consistency validation was performed i n 26 patients of esophageal or pulmonary diseases combined with severe emphysema .SETTING and PARTICIPANTS:Twenty-six patients with esophageal or pulmonary dis eases combined with severe emphysema received surgical treatment. All the operat ions were carried out in Department of Thoracic Surgery, Daping Hospital of Thir d Military Medical University.INTERVENTIONS:Eleven patients underwent esophageal or cardiac carcinoma resect ion and gastroesophageostomy. Then, unilateral LVRS was performed using the EZ75 stapling gun. All staple lines were buttressed with bovine pericardial strips. The removed pulmonary tissues damaged by emphysema made up about 25%-30% of the unilateral lung parenchyma. The resection was performed on the basis of preo perative imaging examinations, what was seen at surgery and the volume of the pa rt of stomach in thorax. Lobectomy and wedge resection involving the lesions wer e completed in 9 patients with lung cancer and 6 patients with benign diseases, respectively. Then, fibrin sealant was insufflated in case of air leakage. The p re- and post-operative pulmonary functions were compared. MAIN OUTCOME MEASURES:Pre- and post-operative changes of the following inde xes: dyspnea index,forced expiratory volume within 1 seco

关 键 词：同期手术 肺减容术 肺恶性肿瘤 食管恶性肿瘤 手术治疗 肺功能 运动能力 重度肺气肿 

分 类 号：R734.2[医药卫生—肿瘤] R735.1[医药卫生—临床医学]