单侧胸腔镜下肺减容术治疗老年性大疱型肺气肿

Lung volume reduction surgery under unilateral thoracoscope for treatment of senile bullous emphysema

摘要:

探讨单侧胸腔镜下行肺减容术（LVRS）治疗老年性慢性阻塞性肺疾病（COPD）的方法及疗效。方法经严格掌控手术适应证，30 例重度大疱型肺气肿的患者被纳入手术，术中应用腔镜用切割缝合器（Endo GIA）切除无功能肺组织，切除部分占肺容积的20%～30%。对比术前、术后3、6 和12 个月的肺功能、血气及6 min步行试验等监测指标。结果30 例患者无死亡病例，术后随访肺功能、血气指标改善，呼吸困难症状减轻，活动耐力不同程度增加。术后3、6 和12 个月比较第1 秒用力呼气量（FEV1）、最大肺活量（FVC）、肺残 气量（RV），差异有统计学意义，术后3 个月血氧分压（PO2）、6 min 步行实验（6MWT）与术后12 月比较差异有统计学意义。结论胸腔镜下行肺减容术对于大疱型肺气肿是一种有效的治疗方法，可改善患者术后活动能力，提高患者生活质量，近期手术效果明显，随着时间延长手术效果有减退趋势。

Abstract:

To discuss the method and efficacy of lung volume reduction surgery (LVRS) under unilateral thoracoscope as the treatment for senile bullous emphysema. Methods A total of 30 cases with severe bullous emphysema were selected for surgery under rigorous surgical indications. Endoscopic cutter stapler (Endo GIA) was applied in the operation to remove the non-functioning lung tissue, which accounted for 20%-30% of the total lung volume. Then, monitoring indexes including pulmonary function, blood gas analysis and 6-min walking test were checked before operation, 3, 6 and 12 months after surgery, and compared. Results No death occurred among the 30 cases. Follow-up survey showed relief of dyspnea and improvement of pulmonary function and blood gas indexes, and increase of activity tolerance in different degrees. Comparison of the levels of FEV1, FVC and RV in 3rd, 6th and 12th months after surgery showed significant differences. PO2 and 6-min walking test 3 months after surgery were significantly different from those 12 months after surgery. Conclusions LVRS under unilateral thoracoscope is an effective treatment for bullous emphysema, which could significantly improve the patients' ability of daily life and quality of life after surgery. The short-term efficacy is obvious after surgery. However, as the time passing the efficacy is in a decreasing trend.