手工缝合肺残面施行肺减容手术治疗重度肺气肿

目的 探讨手工缝合肺残面方法肺减客手术治疗重度慢性阻塞性肺气肿的疗效。方法 本组肺减容手术20例，其中双侧肺减容6例，单侧肺减容14倒。切口的选择依据手术切除靶区的位置，其中平卧位正中切口、双侧LVRS1例，侧卧住后外侧开胸LVRS14侧，前外侧开胸LVRS11侧。术前及术后6月查肺功能（FEV1，TLC，RV）、动脉血气分析、6分钟步行距离进行对比。结果 本组无手术死亡，患者术后肺功能指标比术前有明显改善（P〈0．05），动脉血氧分压术后比术前明显提高（P〈0．05），二氧化碳分压术后比术前明显降低（P〈0．05）；呼吸困难指数再分级，15例术前3级中6例转为1级，9例转为2级；5例4级中1例转为3级，3例转为2级，1例转为1级。结论 重度肺气肿病人行肺减容手术，能改善患者肺功能，提高生活质量。

Lung volume reduction surgery by manual suturing lung stump for treatment of patient with severe emphysema

Objective To evaluate the effect of lung volume reduction surgery (LVRS) by manual suturing lung stump for treatment of severe chronic obstructive emphysema. Methods The LVRS was used in 20 patients, among which 14 unilateral LVRS and 6 bilateral LVRS. The selection of incision depended on the target location of emphysema. Among them, 1 media thoractotomy, 14 posterolateral thoractotomy, 11 anteriolateral thoractotomy. Lung function (FEV1,TLC,RV), arterial blood gas analysis (PO_2,PCO_2) and 6 minutes walking distance test were done before operation and 6 months after LVRS. Results There was no death in this group. The FEV1, TLC, RV were improved significantly after operation (P<0.05), PO_2 increased (P<0.05), PCO_2 decreased significantly postoperatively (P<0.05), 6-minutes walking distance increased(P<0.05) for dyspnea scale, among 15 patients with a preoperative grade of III ,6 patients improved to grade I and 9 patients improved to grade II. Among the 5 patients of grade VI and 1 patient improved to grade III,3 patients improved to grade II,1 patient improved to grade I. Conclusions LVRS can improve the respiratory function and quality of life in selected patients with severe emphysema ,but the long term results was not clear yet.