BILATERAL PNEUMECTOMY (VOLUME REDUCTION) FOR CHRONIC OBSTRUCTIVE PULMONARY-DISEASE
BILATERAL PNEUMECTOMY (VOLUME REDUCTION) FOR CHRONIC OBSTRUCTIVE PULMONARY-DISEASE
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DOI：
10.1016/s0022-5223(95)70426-4
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发表时间：
1995-01-01
影响因子：
6
通讯作者：
ROPER, CL
中科院分区：
文献类型：
--
作者：
COOPER, JD;TRULOCK, EP;ROPER, CL
我们对20例重度慢性阻塞性肺疾病患者施行了双侧肺减容术，以缓解胸胀，改善呼吸力学。手术通过胸骨正中切开进行，切除每个肺体积的20%至30%。受影响最严重的部分通过使用装有牛心包条的线性缝合装置进行切除，牛心包条连接到钉子和钉筒上，以支撑缝合线并消除通过缝合孔的空气泄漏。手术前和术后的结果评估包括呼吸困难和生活质量的分级，运动能力，以及通过肺活量测定和体积描记对肺功能的客观测量。没有早期或晚期死亡，也不需要术后立即进行呼吸机辅助。术后随访1~15个月，平均6.4个月。平均1秒用力呼气量改善了82%，总肺活量、残气量和滞留气体的减少非常显著。这些变化与呼吸困难的显著缓解以及运动耐量和生活质量的改善有关。虽然随访期很短，但这些初步结果表明，双侧手术容量减少对选择严重的慢性阻塞性肺疾病患者可能具有重要价值。
We undertook surgical bilateral lung volume reduction in 20 patients with severe chronic obstructive pulmonary disease to relieve thoracic distention and improve respiratory mechanics. The operation, done through median sternotomy, involves excision of 20% to 30% of the volume of each lung. The most affected portions are excised with the use of a linear stapling device fitted with strips of bovine pericardium attached to both the anvil and the cartridge to buttress the staple lines and eliminate air leakage through the staple holes. Preoperative and postoperative assessment of results has included grading of dyspnea and quality of life, exercise performance, and objective measurements of lung function by spirometry and plethysmography. There has been no early or late mortality and no requirement for immediate postoperative ventilatory assistance. Follow-up ranges from 1 to 15 months (mean 6.4 months). The mean forced expiratory volume in 1 second has improved by 82% and the reduction in total lung capacity, residual volume, and trapped gas has been highly significant. These changes have been associated with marked relief of dyspnea and improvement in exercise tolerance and quality of life. Although the follow-up period is short, these preliminary results suggest that bilateral surgical volume reduction may be of significant value for selected patients with severe chronic obstructive pulmonary disease.