肺减容术治疗慢性阻塞性肺气肿

目的　为了提高肺气肿患者生存质量 ,探讨肺减容手术治疗慢性阻塞性肺气肿的可行性。　方法　本组肺减容手术 16例 ,其中同期双侧肺减容手术 9例 ,胸腔镜辅助小切口肺减容术 4例 ,标准后外侧切口单侧肺减容术 3例。术前根据计算机体层摄影术 (CT)和同位素肺通气肺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型切割缝合器切除病变 ,防止肺泡漏。　结果　手术时间 90～ 2 5 0分钟 ,平均 146分钟 ;主要并发症有肺泡漏≥ 7天 6例 ,心房颤动 2例 ,呼吸衰竭 1例 ,术后胸腔内出血 1例。 13例手术结束即拔出气管内插管 ,3例带管回病房需要机械通气。随访2～ 40个月 ,14例健在 ,术后患者呼吸困难指数上升为 级 1例 , 级 10例 , 级 3例。　结论　慢性阻塞性肺气肿选择性手术能改善患者肺功能 ,长期效果尚需要观察

Lung Volume Reduction Surgery for the Treatment of Chronic Obstructive Emphysema

Objective To investigate the feasibility of lung volume reduction surgery (LVRS) for the treatment of chronic obstructive emphysema. Methods To perform LVRS for 16 patients, of which, simultaneously bilateral LVRS for 9, LVRS via video assisted mini thoracotomy for 4 and unilateral LVRS for 3. The selection of incision depending on the "target" location of emphysema, determined 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. Results The duration of operation was 90- 250 min(mean 146 min). The most frequent complications were prolonged air leak over 7 days in 6 patients, atrial fibrillation in 2, respiratory failure in 1 and intra thoracic bleeding in 1. Thirteen patients were extubated at the end of the operation, 3 required mechanic ventilation postoperatively. Follow up 2-40 months, 14 patients are still alive, but the dyspnea scale increased: 1 grade in 1, 2 grades in 10 and 3 grades in 3. Conclusion LVRS can improve the respiratory function and quality of life for selected patients with emphysema, but the long term results is not clear now.