摘要
目的：探讨并评价以结扎式单肺减容过度气肿肺组织替代传统单肺切割式碱容术（LVRS）治疗重度慢阻肺的疗效、手术指征的选择、总结手术要点及主要并发症漏气的预防和治疗。方法；回顾性分析1999年4月至2003年4月间进行以结扎式切割过度气肿肺组织替代传统单肺减容术治疗的20例重度慢性阻塞性肺部疾病（COPD）的随访资料。术前利用CT扫描确定靶区。选择估计对肺功能影响较大的一侧肺先行手术，结扎式切除肺容量25％～30％左右。比较术前、术后6个月、12个月、24个月的呼吸困难度、肺功能及生活质量的变化来评价以结扎式切割过度气肿肺组织替代传统单侧LVRS的疗效。结果：术后呼吸困难明显改善或消失．呼吸困难指数从4～5级转为1～2级，平均改善2．6级。肺功能第1s（FEV1）平均增加（43．1±8）％，动脉血氧分压平均上升13．9mmHg。术后1年血气及FEV1改善达高峰，术后1年生存率100％、2年生存率95％，无手术死亡病例，术后并发症发生率30％。结论；以结扎式切割过度气肿肺组织替代传统单肺减容术可以明显改善具有手术适应证COPD患者的临床症状和生理状态，且术后主要并发症肺创面持续漏气明显降低（P〈0．01），无手术死亡。
Objective：To investigate the operative indications, effects,technique, the prevention of air leakage of resection of overinflated pulmonary tissue by ligation instead of traditional Lung volume reduction surgery （LVRS）. Methods： Twenty patients from Apr. 1994 to Apr. 2003 with severe emphysema underwent resection of overinflated pulmonary tissue by ligation instead of traditional LVRS. The targeted area was identified by CT scan. The more severe side was chosen to operation. The effects of ligation instead of traditional LVRS were evaluated by comparing the dyspnea, pulmonary function, living state before operation and 6-months, 12-months, 24-months after operation. Results： After operation dyspenea evidently alleviated or disappeared. The dysp- nea index improved by mean 2. 6 grade from grade 4-5 to grade 1-2. Pulmonary function FEV1 increased by （43.1±8%） SaO2 increased by 13. 9mmHg. The PaO2 and FEV1 improve to peak one year later. The 1-yr survival rate after operation was 100%, 2-yr survival rate after operation was 95%. There was no operative death. The complication rate was 30%. Conclusion. The resection of overinflated pulmonary tissue by ligation instead of traditional LVRS provide significant clinical and physiological improvement for patients with severe emphysema. It can reduce the main complication such as the air leakage of lung. There was no operative death.
出处
《实用临床医学（江西）》
CAS
2006年第1期15-17,共3页
Practical Clinical Medicine
基金
江西省科委课题
关键词
慢性阻塞性肺部疾病
肺气肿
肺减容术
外科学
chronic obstructiv pulmonary disease
emphysema
lung volume reduction surgery sargery
