肺减容术治疗重度肺气肿患者临床分析

目的探讨肺减容手术的治疗效果及安全性。方法回顾性分析2004年1月至2007年6月24例因重度肺气肿而行肺减容手术患者的临床资料。术前根据肺功能指标、血气分析、心脏功能和活动能力等综合因素筛选病例并行呼吸道准备，根据胸部CT、同位素肺灌注扫描等检查方法选择手术“靶区”。其中2例采用胸骨正中切开行双侧减容术，22例采用标准后外侧切口单侧肺减容手术。术中使用带垫片的直线型切割缝合器切除严重气肿的肺组织。结果术后出现并发症7例，其中肺泡漏气≥7d者4例、心律失常2例、肺炎1例。无手术死亡病例。术后平均随访19个月，所有患者术后肺功能明显改善、呼吸困难减轻，生活基本自理。其中14例术后呼吸困难指数上升Ⅰ级1例、Ⅱ级10例、Ⅲ级3例。结论肺减容手术可使部分重度肺气肿患者肺功能得到一定程度的改善；术前严格筛选手术病例和围手术期正确处理是肺减容手术安全的前提。

Clinical analysis for patients with severe chronic emphysema treated by lung volume reduction surgery

Objective To study effectiveness and safety of lung volume reduction surgery(LVRS) in treatment for severe chronic emphysema(chronic obstructive pulmonary disease).Methods Clinical data of 24 patients of severe chronic emphysema undergone with LVRS during January 2004 to June 2007 were analyzed retrospectively.LVRS was performed for the patients after respiratory tract preparation based on their pulmonary function,results of blood gas analysis,cardiac function,as well as physical activity capacity.and surgical incision Was selected based on"target"location of emphysema with chest computerized tomography and isotope lung perfusion scanning,22 cases with standard unilateral LVRS via outer post-lateral incision and two with bilateral LVRS via mid-sternal incison.A linear device for cutting and stitching was used in surgical operation to excise the lung tissues of severe emphysema with strips of bovine pericardium to prevent air leakage.Results All the patients were followed-up for 19 months in average and complications occurred in seven of them after operation,including four with leakage of the alveoli.two with cardiac arrhythmia and one with pneumonia,and no death was observed.Pulmonary function and symptoms of dyspnea improved obviously in all the patients after operation,and they all could care for themselves,in general,with scales of dyspnea increased to grade Ⅰ in one case,to grade Ⅱ in 10 cases and to grade Ⅲ in three cases.Conclusions LVRS can improve pulmonary function of selected patients with severe emphysema,to certain extent,and its safety will depend on strict selection of the patients and correct peri-operative care.