摘要
目的探讨肺移植和肺减容手术(LVRS)治疗终末期肺气肿患者的临床疗效及卫生经济学指标,为临床选择治疗方案提供参考。方法回顾性分析自2002年9月至2008年8月无锡市人民医院61例终末期肺气肿患者行LVRS和肺移植术治疗的临床资料,根据手术方式不同将61例患者分为3组,LVRS组:39例,行单侧肺减容术;单肺移植术(SLTx)组:14例,行SLTx;双肺移植术(BLTx)组:8例,行BLTx。于围术期、术后6个月、1年和3年住院复查肺功能、血气分析指标、6 min步行距离(6-MWD)的改变,观察1年、3年生存率。并通过成本-效用分析进行卫生经济学评价。结果术后6个月、1年和3年LVRS组、SLTx组和BLTx组FEV1.0较术前分别改善75%、83%和49%,176%、162%和100%,260%、280%和198%;LVRS组、SLTx组和BLTx组FVC分别较术前改善21%、41%和40%,68%、73%和55%,82%、79%和89%;LVRS组、SLTx组和BLTx组6-MWD分别较术前增加75%、136%和111%,513%、677%和608%,762%、880%和741%。LVRS组、SLTx组和BLTx组患者1年、3年生存率分别为74.40%和58.90%,85.80%和64.30%,62.50%和50.00%。SLTx组随访3年的成本-效用比高于BLTx组(1 668.00 vs.1 168.55,P<0.05)和LVRS组(1 668.00 vs.549.46,P<0.05)。结论 SLTx、BLTx组术后各项功能指标较LVRS组明显改善。3年内成本-效用分析结果表明,LVRS组更经济、实惠。随着医疗技术的进步、移植医疗费用的降低、免疫抑制剂的国产化价格降低,肺移植总费用也随之降低,肺移植术将成为终末期肺气肿患者首选的外科治疗方法。
Objective To evaluate the clinical effects and health economics of lung volume reduction surgery（LVRS）,single lung transplantation（SLTx） and bilateral lung transplantation（BLTx） for patients with end-stage emphysema.Methods A total of 61 patients with end-stage emphysema,including 39 patients who underwent LVRS（LVRS group）,14 patients who underwent SLTx（SLTx group）,and 8 patients who underwent BLTx（BLTx group） from September 2002 to August 2008 in Wuxi People＇s Hospital,were analyzed retrospectively.Lung function,arterial blood gas analysis and 6-minute walk distance（6-MWD） were assessed before their surgery and 6 months,1-year and 3-year after their surgery respectively.Their 1-year and 3-year survival rates were observed.Cost-effectiveness analyses were made from a health economics perspective.Results Compared with their preoperative results,their mean forced expiratory volume in 1 second（FEV1.0） in LVRS group increased by 75%,83% and 49% at 6 months,1-year and 3-year postoperatively,by 176%,162% and 100% in SLTx group,and by 260%,280% and 198% in BLTx group respectively.Their mean forced vital capacity（FVC） in LVRS group increased by 21%,41% and 40% at 6 months,1-year and 3-year postoperatively,by 68%,73% and 55% in SLTx group,and by 82%,79% and 89% in BLTx group respectively.Their exercise endurance as measured by 6-MWD increased by 75%,136% and 111% in LVRS group at 6 months,1-year and 3-year postoperatively,by 513%,677% and 608% in SLTx group,and by 762%,880% and 741% in BLTx group respectively.The 1-year and 3-year survival rates after operation were 74.40% and 58.90% in LVRS group,85.80% and 64.30% in SLTx group,and 62.50% and 50.00% in BLTx group respectively.The three years＇ cost utility of SLTx group was significantly higher than that of BLTx group（1 668.00 vs.1 168.55,P0.05）and LVRS group（1 668.00 vs.549.46,P0.05）. Conclusion SLTx and BLTx are better than LVRS in improving patients＇ lung function and exercise endurance for end-stage emphysema patients.
出处
《中国胸心血管外科临床杂志》
CAS
2012年第2期141-144,共4页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
国家"十一五"科技支撑计划基金资助项目(2008BAI160B05)~~
关键词
终末期肺气肿
肺减容术
肺移植
成本-效用
End-stage emphysema
Lung volume reduction surgery
Lung transplantation
Cost-utility
