摘要
目的探讨利用自体心包作垫衬行肺减容手术(LVRS)治疗重度慢性阻塞性肺气肿的可行性及临床价值。方法本组肺减容手术23例,其中经前外侧或腋下小切口单侧肺减容19例,经胸骨正中切口双侧肺减容4例。根据术前CT显示的肺气肿手术"靶区",术中取自体心包作垫衬,直线切割缝合器切除病变,术前、术后查肺功能、动脉血气分析,进行对比。结果本组死亡1例,余22例痊愈出院。动脉血氧分压(PaO2)术后比术前明显提高(P<0.05),二氧化碳分压(PaCO2)术后比术前明显降低(P<0.05);术后FEV1比术前有明显改善(P<0.05),RV、TCL较术前有明显降低(P<0.05);术后患者呼吸困难指数上升为Ⅰ级6例,Ⅱ级12例,Ⅲ级4例。结论LVRS可以明显改善重度慢性阻塞性肺气肿患者的肺功能,提高近期生活质量。自体心包取材方便、不增加副损伤、手术费用大幅降低,对LVRS在国内的推广和开展具有重要的意义。
Objective To evaluate the effect of lung volume reduction surgery （LVRS） for treatment of severe chronic obstructive emphysema. Methods The LVRS was performed in 23 patients,among which, 19 unilateral LVRS and 4 simultaneously bilateral LVRS. The selection of incision depended on the target location of emphysema and was determined by computed tomography scan. A linear stapling device was used to excise the most emphysematous portion of lung. The results of lung function （FEV1, RV, TLC） and arterial blood gas analysis （PaO2, PaCO2） were done before and 1 and 12 months after LVRS. Results There was 1 perioperative death in this group. The FEV1 ,RV,TLC were improved significantly after surgery （P〈0.05）. For dyspnea scale, 6 patients improved to grade Ⅰ ,and 12 improved to grade Ⅱ , 4 patients improved to grade Ⅲ. Conclusion LVRS can improve the respiratory function and quality of life in selected with severe emphysema. Autologous pericardium pad is a simple.convenient and effective material for LVRS,h is worthwhile to disseminate widely.
出处
《重庆医学》
CAS
CSCD
2008年第20期2319-2320,共2页
Chongqing medicine
关键词
自体心包
肺减容手术
重度慢性阻塞性肺气肿
autologous pericardium
lung volume reduction surgery
severe emphysema
