胸腔镜肺减容术治疗慢性阻塞性肺气肿终末期的临床疗效(附18例)

目的:探讨胸腔镜肺减容术治疗慢性阻塞性肺气肿终末期的临床应用价值。方法:回顾性分析腔镜下肺减容手术18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,经胸腔镜肺减容术,术中使用腔内切割缝合器切除病变,并用奈维补片(可吸收聚乙醇酸修补材料)防止肺泡漏气。结果:全组病例无围术期死亡,所有患者气促症状明显改善。结论:胸腔镜下肺减容术能改善慢性阻塞性肺气肿终末期患者肺功能,缓解呼吸困难,提高运动能力,但远期效果却有待观察。     

电视胸腔镜双侧肺减容术21例

目的总结电视胸腔镜双侧肺减容术(BLVRS)治疗慢性阻塞性肺气肿(COPE)的临床经验,并观察其疗效。方法 2009年9月至2010年9月,南京医科大学附属南京医院对21例COPE患者行电视胸腔镜BLVRS,均为男性,年龄(65.71±9.05)岁。采用电视胸腔镜专用切缝器(Endo-GIA)切除过度充气的肺大泡组织,常规用4-0Prolene线连续往返缝合。术后观察患者的肺功能、血气分析指标和6 min步行距离(6-MWD)的变化,并与术前进行比较,评价手术疗效。结果无围术期死亡,术后住院时间(13.20±4.60)d,胸腔引流时间(5.33±3.67)d。术后持续肺漏气(5.91±3.52)d 12例,出现急性呼吸衰竭1例,广泛皮下气肿2例,合并肺部感染5例,均经相应的处理治愈。随访21例,随访时间6个月,术后6个月第1秒用力呼气容积[(1.63±0.23)L vs.(1.21±0.17)L]、动脉血氧分压[(77.62±6.98)mm Hg vs.(67.54±8.12)mm Hg]和6-MWD[(430.55±80.49)m vs.(283.48±108.12)m]较术前增加,动脉血二氧化碳分压(PaCO2)、、残气量(RV)较术前降低(P<0.05)。结论电视胸腔镜BLVRS安全、有效,特别对非均质性肺气肿,可明显改善患者的生活质量,近期效果显著。     

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     

胸腔镜肺减容术治疗慢性阻塞性肺气肿的临床疗效

目的:分析胸腔镜肺减容术治疗慢性阻塞性肺气肿的手术疗效。方法:回顾分析2003年4月至2012年4月为91例慢性阻塞性肺气肿患者行肺减容手术的临床资料,其中71例行胸腔镜手术(腔镜组),20例行传统开胸手术(对照组)。对比两组患者住院时间、术中出血量、带管时间、胸引量及患者疼痛程度,并分析两组患者的肺功能与血气指标。结果:腔镜组住院时间、带管时间较短,术中出血量、胸引量少,患者疼痛程度轻,与对照组相比差异均有统计学意义(P0.05)。两组患者肺功能、血气指标如1秒用力呼气容积、残气量、动脉氧分压及二氧化碳分压术后均得到改善(P0.05),但两组间差异无统计学意义(P0.05)。结论:胸腔镜肺减容术治疗慢性阻塞性肺气肿具有患者创伤小、康复快的优点,是理想的治疗方式。     

电视胸腔镜下肺减容术治疗重度肺气肿6例

目的 评价电视胸腔镜下肺减容术治疗重度肺气肿的疗效。方法 对6例重度肺气肿进行胸腔镜肺减容术,其中同期双侧2例,单侧4例。切除一侧肺容积约25％-30％。结果 无手术死亡,随访3-17个月,FEV1和PaO2增加24.6％和8.3％。RV、TLC和气道阻力分别下降24．6％、20．3％、47．1％。结论 严重肺气肿患经肺减容术后呼吸困难缓解,生活质量改善。     

胸腔镜肺减容术治疗重度肺气肿

2000年1月至2004年3月，我们应用电视胸腔镜肺减容手术（LVRS）治疗重度肺气肿32例，取得较满意的治疗效果，现报道如下。     

重度阻塞性肺气肿行双侧肺减容术

<正> 2000年12月我科为1例重度阻塞性肺气肿合并肺性脑病、肺心病患者施行双侧肺减容手术,并以人工缝合技术替代进口机械缝闭器缝合肺残面,术后无漏气,病人手术后心肺功能均较手术前有了明显改善,术后一年随访,一般状况良好,取得较好疗效,现报告如下。 1 临床资料 1.1 一般资料:患者,男性,50岁,练钢工人,身高     

肺减容术治疗肺气肿

肺减容术治疗肺气肿方文涛综述黄偶麟陈文虎审校肺气肿是慢性阻塞性肺病（ＣＯＰＤ）的一种，目前常规的治疗方法是内科保守治疗和功能锻炼，但对晚期患者疗效不佳。８０年代开始以肺移植治疗终末期肺气肿取得了一定的成果，近年来关注较多的即为肺减容术（ｌｕｎｇｖｏｌ...     

肺减容术治疗肺气肿

肺减容术治疗肺气肿钟南山慢性阻塞性肺气肿是我国的常见病。美国胸科学会对肺气肿所下的定义为：“肺气肿是肺内与终末细支气管相通的气腔持久性地异常扩大，并伴有肺泡壁的破坏，但无明显的纤维化。所谓肺泡壁的破坏系指呼吸气腔不均匀性扩大，肺泡及其结构成分排列紊乱...     

肺减容术治疗重度肺气肿临床探讨

目的 研究肺减容术对重度肺气肿的手术适应证和临床疗效。方法 选择２０例重度肺气肿患者,经胸骨正中劈开切口或电视辅助胸腔镜途径,用直线切割缝合器或Ｅｎｄｏ ＧＩＡ,切除因过度膨胀而破坏的、无功能肺组织。每侧肺切除其容量的２０％￣３０％。结果术后呼吸困难明显减轻或消失;９５％患者呼吸困难指数从４￣５级转变为１￣２级。肺功能１秒时间肺活量（ＦＥＶ１）增加４１．４％,残气量（ＲＶ）和肺总量（ＴＬＣ）分别     

Thoracoscopic lung volume reduction surgery for pulmonary emphysema patients with severe hypercapnia

OBJECTIVES: We assessed whether hypercapnia patients with an extremely high level of PaCO2 > or = 60 mmHg were suitable candidates for lung volume reduction in the treatment of severe pulmonary emphysema. METHODS: Of 65 patients undergoing lung volume reduction surgery between May 1993 and August 1997, 6 (9.23%) who had a preoperative rest room air blood gas level of PaCO2 > or = 60 mmHg were selected for study. All patients underwent video-assisted thoracoscopic surgery. Of the 6 with severe hypercapnia, 5 underwent the unilateral procedure and 1 the bilateral procedure. RESULTS: All severe hypercapnia patients showed significant clinical improvement. When assessed at 3 to 6 months after lung volume reduction surgery, significant improvements were seen in mean forced expiratory volume in 1 second (preop: 0.44 +/- 0.04 L; postop: 0.74 +/- 0.20 L; p < 0.01), for a magnitude improvement of 69.8%, and in trapped gas volume (preop: 3.28 +/- 1.11 L; postop: 1.61 +/- 1.02 L; p < 0.05). Arterial blood gas analysis showed significant improvement in PaO2 from 51.1 +/- 6.68 mmHg to 69.8 +/- 7.87 mmHg (p < 0.001) with a decrease in PaCO2 from 70.4 +/- 9.41 mmHg to 46.9 +/- 3.44 mmHg (p < 0.01). Postoperative follow-up averaged 55 months (43-69 months). All but 1 patient remain alive and well. CONCLUSION: Patients with severe pulmonary emphysema accompanied by hypercapnia can gain relief and a better quality of life through volume reduction surgery and should not be excluded from surgical treatment simply based on this condition. Selection should involve a comprehensive view of the patient's condition that includes criteria such as the results of radiographic diagnosis and detailed pulmonary function tests.     

肺减容手术治疗重度肺气肿的临床研究

目的评价肺减容手术对重度肺气肿患者的疗效。方法36例重度肺气肿患者行肺减容手术,双侧8例,单侧28例。术前、术后3、6个月分别测量动脉血气(PaO2,PaCO2)、肺功能(FEV1、RV、TLC)、6分钟运动试验(6-MWD),并对其结果进行比较分析。结果本组无手术死亡,均痊愈出院;术后动脉血氧分压比术前明显提高(P<0.05),二氧化碳分压比术前明显降低(P<0.05);术后3、6个月的FEV1、6-MWD较术前有明显提高(P<0.05),RV、TLC较术前有明显降低(P<0.05);呼吸困难指数再分级,26例术前Ⅲ级中10例转为Ⅰ级,16例转为Ⅱ级;10例Ⅳ级中3例转为Ⅰ级,5例转为Ⅱ级,2例转为Ⅲ级。结论重度肺气肿患者选择性手术,能改善患者肺功能,提高生活质量。     

电视胸腔镜辅助小切口在肺容积减少术治疗重度慢性阻塞性肺气肿的临床疗效分析

目的评估电视胸腔镜辅助小切口在肺容积减少术治疗重度慢性阻塞性肺气肿(COPD)的临床疗效。方法对28例COPD患者采用胸腔镜下辅助小切口行肺容积减少术,其中单侧20例,双侧同期8例。根据术前胸部CT确定的靶区位置,切除过度充气的肺组织。比较COPD患者术前及术后6个月的肺功能、血气分析指标和活动能力的变化。结果 28例患者均于术后6³3 d康复出院,术后2例并发急性呼吸衰竭,1例死亡。3例并发肺部感染,4例并发持续漏气(时间最长达25 d)。术后3个月呼吸困难指数从Ⅲ33 d康复出院,术后2例并发急性呼吸衰竭,1例死亡。3例并发肺部感染,4例并发持续漏气(时间最长达25 d)。术后3个月呼吸困难指数从Ⅲ^Ⅳ级转为IⅣ级转为I^Ⅱ级,肺总量(TLC)及功能残气量(RV)较术前改善(P<0.05)。第1秒用力呼气容积(FEV1)、PaO2、PaCO2和6 min步行距离等明显改善(P<0.01)。结论对重度COPD患者行电视胸腔镜辅助小切口肺容积减少术具有独特的优势,能显著改善其呼吸功能、缓解临床症状、改善生活质量,效果肯定,安全可靠,是一种有效的治疗方法,有良好的临床应用价值。     

肺减容手术(LVRS)治疗重度阻塞性肺气肿

目的探讨重度肺气肿采用肺减容术的适应症、围手术期准备及手术方法。方法对6例重度肺气肿患者施行肺容积减少术，其中间期双侧2例，单侧4例。为控制肺切面漏气，缝合时衬以牛心包片。本组切除一侧肺容积25％—30％。结果无手术死亡。术后2例并发急性呼吸衰竭，经积极抢救处理而治愈。术后随诊3—12个月，肺功能有明显改善，PaO2均有显著上升，PaCO2亦有所下降。结论肺减容术是治疗严重肺气肿的有价值的治疗方法之一。     

Correlation of unilateral thoracoscopic lung volume reduction with improvement in lung function and exercise performance in patients with severe pulmonary emphysema

1 ), forced vital capacity, static compliance, and maximal oxygen uptake. The functional residual capacity as measured by the gas dilution method (FRC_gas), was unchanged; however, it was found to be decreased significantly when measured by body plethysmograph (FRC_box). Positive correlations existed between the reduction in FRC_box and the increase in FEV₁ (r = 0.586, P = 0.0042) and maximal oxygen uptake (r = 0.550, P = 0.018). Pulmonary ventilation and exercise ability in patients with pulmonary emphysema were improved in a volume-dependent manner by thoracoscopic lung volume reduction. These findings indicate that patients with a preoperative trapped gas volume level exceeding 1 l would be ideal candidates for thoracoscopic lung volume reduction. (Received for publication on Mar. 4, 1998; accepted on Jan. 7, 1999)     

肺减容术后早期肺功能及肺血流动力学的变化

目的　探讨肺减容手术 (LVRS)治疗重度慢性阻塞性肺气肿病人 (COPD)术后早期肺功能及肺血流动力学的变化。方法　 31例重度COPD病人行LVRS手术 ,双侧 11例、单侧 2 0例。术前、术后3、6个月分别测量动脉血气 (PaO2 、PaCO2 )、心脏超声多普勒检查 (CO、CI、FS、EF、PAP)、肺功能 (FEV1 、RV、TLC)、6分钟运动试验 (6 MWD) ,并对其结果进行比较分析。结果　 2 6例痊愈出院 ,5例死亡 ;单侧LVRS术后 3、6个月的FEV1 、6 MWD较术前有明显提高 (P <0 0 1) ,双侧LVRS术后各项指标改善较单侧更好(P <0 0 1) ,RV、TLC较术前有明显降低 (P <0 0 1) ;术后动脉血氧分压比术前提高 (P <0 0 5 ) ,二氧化碳分压较术前显著减低 (P <0 0 1) ;心功能 (CI、CO、EF、FS)及肺动脉压力无明显变化 (P >0 0 5 )。结论　LVRS切除肺靶区 2 0 %～ 30 %治疗重度COPD有效 ,术后早期肺功能明显改善、PaO2 提高、PaCO2 降低 ,而对心功能、肺动脉压力无明显负影响.     

电视胸腔镜下肺减容术治疗重度慢性阻塞性肺气肿68例

目的 评价电视胸腔镜肺减容术治疗慢性阻塞性肺气肿的临床疗效.方法 回顾性分析2002年6月至2012年6月,68例重度慢性阻塞性肺气肿患者施行肺减容术的随访资料.随访观察对比术前及术后6个月、1年和2年的第1秒用力呼气量(FEV1.0)、最大肺活量(FVC)、残气量(RV)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)和6 min步行距离(6-MWD)的改变.结果 术后患者肺功能、血气指标、6 min步行距离均有明显改善.结论 胸腔镜肺减容术能明显改善部分具有手术适应证的重度慢性阻塞性肺气肿患者的临床症状和生理状况,提高生活质量.     

A prospective analysis of the inter-relationship between lung volume reduction surgery and body mass index

Objectives: LVRS is thought to result in significant improvements in BMI. Patients with a higher BMI at the time of diagnosis of COPD are known to have better survival, and those with a low BMI prior to LVRS have significantly worse perioperative morbidity. We aimed to assess the influence of BMI on the outcome of LVRS in our own experience. Methods: Complete preoperative BMI data was available in 114 of 131 consecutive patients who have undergone LVRS since 1995. These patients were arbitrarily classified into three categories: underweight (BMI ≤ 19 kg/m²), normal (BMI 20–25 kg/m²) and overweight (BMI > 26 kg/m²). The in-hospital course and perioperative change in BMI at 3, 6, 12, 24 and 36 months were prospectively recorded for each category and compared. Results: There were no significant differences in preoperative variables except BMI. There were significantly more postoperative ITU admissions among the lowest two BMI groups (12/29, 18/58 and 3/27 patients, respectively, p = 0.02), and significantly shorter hospital stay in overweight patients [16 days (5–79) vs 18 days (6–111) vs 13 days (6–25), respectively, p = 0.005, expressed as median (range)]. However, there was no difference in survival between the three groups (p = 0.21). Postoperative physiological improvements in the first year were related to preoperative BMI for both FEV₁ (r = 0.29, p = 0.02) and DLCO (r = 0.33, p = 0.02). Postoperative BMI significantly increased in the underweight yet significantly decreased in the overweight at all time points. Conclusions: The perioperative course of LVRS and its physiological benefits are influenced by preoperative BMI. Whilst the treatment of the underweight is more complicated, LVRS may be the only way of increasing their BMI. Future work is needed to explore the roles of changing energy requirements and body composition following LVRS.     

肺切除并肺减容术治疗肺癌及重度肺气肿

目的　总结 3例早、中期非小细胞肺癌合并重度肺气肿病人施行一侧肺切除并对侧肺减容术的治疗经验。方法　 3例男病人 ,年龄 6 0～ 6 4岁。鳞癌 2例 ,腺癌 1例。 2例癌肿位于右上肺叶 ,1例在左下肺叶。分期Ib 期 2例 ,IIa期 1例。术前气急分级 :2级 1例 ,3级 2例 ,第一秒用力呼气量(FEV1)平均 0 90L(36 3%预计值 )。动脉血氧分压 (PaO2 )平均 73 5mmHg(1mmHg =0 133kPa)。 6min行走平均 2 87 7m。肺癌行肺叶切除 2例、肺楔形切除 1例 ;同期切除对侧肺组织 (靶区 ) 2 0 %～ 30 %。结果　 3例病人术后恢复顺利。术后近期病人自觉症状如胸闷、气急等改善 ,气急指数均比原先上升 1级。随访 1～ 6个月FEV1较术前上升 0 40L ,PaO2 增加 2 0 5mmHg,6min行走增加增加 46 7% (平均 42 1m)。结论　对有选择的早中期肺癌合并重度肺气肿病例 ,同期施行肿瘤一侧肺切除及对侧肺减容术是适宜的治疗方法 ,从而扩大了肺癌的手术适应证。     

Thoracoscopic bilateral lung volume reduction for diffuse pulmonary emphysema

Objective: In a prospective study, we investigated the functional results, complications and survival of bilateral video-assisted thoracoscopic (VAT) lung volume reduction (LVR) in a selected group of patients with severe, nonbullous pulmonary emphysema. From January 1994 to September 1996, 42 of 143 candidates (13 female, 29 male, 42–78 years) were operated. They were short of breath on minimal exertion due to severe airflow obstruction and hyperinflation (FEV1<30% pred., TLC>130% pred., RV>200% pred.). Methods: LVR was performed bilaterally by VAT using endoscopic staplers without buttressing the staple lines. Pulmonary function test (PFT), MRC dyspnea score and 12 min walking distance were assessed preoperatively, at 3, 6 and 12 months. In addition lung function was measured at hospital discharge. Results: The patients reported a marked relief of dyspnea, which persisted at all follow-up visits (P<0.001). FEV1 increased from 0.80±0.24 (L) to 1.14±0.41 (L) postoperatively, a 43% gain (P<0.001). A relevant increase of FEV1 persisted for at least 1 year. The residual volume to total lung capacity ratio decreased from 0.64 to 0.56 at hospital discharge. The mean 12 min walking distance increased from 500±195 (m) to 770±222 (m) after 1 year (P<0.001). The mean hospital stay was 13±5.5 days (median 12.0), drainage time was 9±4.3 (median 8.0) days. There was no 30 day mortality. Three patients died between 2 and 15 months postoperatively by non surgery related reasons. One patient underwent lung transplantation 5 months after surgical lung volume reduction. Conclusions: In a selected group of patients with severe, nonbullous pulmonary emphysema, bilateral LVR by VAT results in instantaneous postoperative improvement in pulmonary function and dyspnea. These favorable effects, including an amelioriation in exercise performance, lasted for at least 1 year.