用常规器械行肺体积缩小术治疗重度肺气肿的探讨

目的：探索用常规器械实施肺体积缩小术(LVRS)的安全方法。方法：对3只杂种犬的肺叶用钳夹—缝合、国产消化道缝合器(XF)、或XF加垫片缝合等方法行部分切除，观察其优缺点。用由上述实验得出的安全方法对重度肺气肿病人经腋下斜切口行LVRS，观察治疗效果及费用。结果：钳夹—缝合及XF加牛心包垫片缝合时均能避免肺切缘处出血和漏气；但前者较耗时。用钳夹—缝合及XF加牛心包垫片等方法共对5例患者实施了单侧(2例)或双侧(3例)LVRS，过程顺利；术后未发生严重漏气；出院时肺功能均明显改善；治疗费与同期普通肺切除术相当。结论：用钳夹—缝合或XF加垫片缝合法行肺部分切除不引起严重漏气。用常规器械经腋下斜切口行LVRS能治疗重度肺气肿，并可大幅度降低手术费用。

LUNG VOLUME REDUCTION SURGERY WITH CONVENTIONAL STAPLER FOR TREATMENT OF SEVERE EMPHYSEMA

Objective:To develop a low-cost approach of lung volume reduction surgery LVRS to treat patients with severe emphysema. Methods:Three mongrel dogs were used to screen a safe method from the following: clamp and suture (C&S), stapling with conventional stapler only, stapling with conventional stapler attaching with dacrons strips, or stapling with conventional stapler attaching with bovine pericardium strips, for pulmonary resection. Thereafter, patients with severe emphysema underwent LVRS through subaxillary oblique minithoracotomy using the best methods screened from the animal study. Results:The animal study showed that air leakage and bleeding through the cutting edges were eliminated when pulmonary resection was accomplished either by C&S or by a conventional stapler with strips of bovine pericardium to buttress the staple line; but suturing same pulmonary excision with C&S consumed more time than with a conventional stapler. 25% volume of one (n=2) or both (n=3) sides of the lungs in 5 patients with severe emphysemas was excised with conventional stapler fitted with bovine pericardium strips and C&S. Neither bleeding nor air leakage from the cutting edges was observed. The patients gradually weaned from oxygen requirement and could climb twelve steps of stairs when they discharged. The hospital expenses of the cases were about the same amount as ordinary lung surgery. The patients survived well during the period of follow-up.Conclusions: We conclude that LVRS by C&S and stapling with conventional staplers fitted with bovine pericardium strips is a safe, low-cost approach for surgical treatment of severe emphysema.