【摘要】 目的　评价单侧肺减容术 (LVRS)治疗慢性阻塞性肺疾病 (COPD)的疗效、手术适应证和禁忌证 ,总结手术操作要点。方法　回顾性分析中日友好医院胸外科在 1998年 1月～ 2 0 0 2年 12月间进行单侧LVRS的COPD患者 (2 5例 )的随访资料。术前利用CT和核素肺通气灌注扫描确定“靶区”。 2 5例患者中 4例行标准后外侧切口手术 ,2 1例行胸腔镜或胸腔镜辅助小切口手术 ;直线切割缝合器 (Linerstapler)或胸腔镜专用缝切器 (EndoGIA)加牛心包垫切除过度充气破坏的肺组织。比较术前、术后 1年、术后 2年的呼吸困难程度、肺功能及生活质量等指标的变化 ,以评价单侧LVRS的有效性。结果　单侧LVRS后一秒钟用力呼气容积 (FEV1)平均提高 (35± 9) % ;6分钟步行距离(6MWD)平均提高 (88± 2 2 ) % ;呼吸困难指数再分级 ,16例术前Ⅳ级中 4例转为Ⅰ级 ,12例转为Ⅱ级 ;9例术前Ⅴ级中 1例转为Ⅰ级 ,1例转为Ⅱ级 ,4例转为Ⅲ级 ,3例转为Ⅳ级。Karnofsky评分平均提高 (4 4± 10 )分。本组 1年、2年生存率分别为 96 %、92 % ,无手术死亡 ,术后并发症发生率为 32 %。结论　单侧LVRS可以改善具备手术指征的COPD患者的临床症状 ,且手术病死率低。尽量切除术侧无功能肺组织 ,防止肺漏气为手术要点 ,术前、术后呼吸功能锻炼有助于患者术后?更多还原

【Abstract】 Objective To evaluate the effectiveness of unilateral lung volume reduction surgery(LVRS) in patients with chronic obstructive pulmonary disease(COPD). Methods The follow-up data of 25 patients with COPD who had underwent unilateral LVRS between January 1996 to December 2002 in department of thoracic surgery,China-Japan friendship hospital were analyzed retrospectively. The operative target was determined by pre-operative CT and pulmonary ventilation-perfusion( V ·/ Q ·) scintigraphy. LVRS was performed in 21 patients through video assisted thoracoscopy surgery(VATS) or VATS with adjuvant small lateral thoracotomy. In 4 patients LVRS was performed through posterolateral thoracotomy. Destroyed pulmonary tissue was resected by liner stapler or Endo GIA. To evaluate the effectiveness of unilateral LVRS,the changing of dyspnea score,pulmonary function and the quality of life were analyzed. Results The postoperative follow-up interval range was 2 years. The mean postoperative FEV 1 increased by (35±9)%,and six minute walking distance(6MWD) increased by (88±22)%. For dyspnea score,among 16 patients with a preoperative grade of Ⅳ,4 patients improved to grade Ⅰ,12 improved to grade Ⅱ;among 9 patients with a preoperative grade of Ⅴ,1 improved to grade Ⅰ,1 improved to grade Ⅱ,4 improved to grade Ⅲ,and the other 3 improved to grade Ⅳ. Karnofsky score increased by (44±10) in average. One and two year survival rates was 96% and 92%,respectively. There was no perioperative death in this group,and the total postoperative morbidity was 32%. Conclusions Unilateral LVRS shows significant clinical benefits for the majority of patients with COPD. It is associated with lower operative mortality and morbidity,and has a wide range of indications. The key points of the operation are to resect dysfunctional lung tissues as much as possible and to prevent pulmonary air leak. Preoperative and postoperative breathing training plays a very important role in the postoperative recovering of lung function.更多还原