Bilateral volume reduction surgery for diffuse pulmonary emphysema by video-assisted thoracoscopy
Bilateral volume reduction surgery for diffuse pulmonary emphysema by video-assisted thoracoscopy
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DOI：
10.1016/s0022-5223(96)70086-7
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发表时间：
1996-10-01
影响因子：
6
通讯作者：
Weder, W
中科院分区：
文献类型：
--
作者：
Bingisser, R;Zollinger, A;Weder, W
我们前瞻性研究了电视辅助双侧胸腔镜肺减容术治疗重度弥漫性肺气肿患者的手术方面、功能结果和并发症。研究方法：15名男性和5名女性，平均年龄64岁（42 - 78岁），因严重气流阻塞和过度充气而导致日常活动严重受损，接受胸腔镜减容手术。前瞻性术前评估和术后3个月评估包括（1）肺功能检查，（2）呼吸困难分级，（3）运动能力;出院前立即进行肺功能检查。结果：无围手术期死亡。所有患者均在中位住院15天（6至27天）后出院。仅7例患者胸管引流时间延长（>7天），（+/-标准差）用力呼气量，在1秒内改善了42%（+/-3.8%），从0.80 L（+/-0，23）降至1.09 L（+/-0，28）（p < 0.001）;残留量从5.8 L（+/-1，5）降至4.4 L（+/-1.0）（p，< 0.001）。出院前不久，1秒用力呼气量已为1.10 L（+/-0.26）。中位12分钟步行距离从495 m（35 - 790 m）增加到688 m（175 - 1035 m）（p < 0.001），平均最大耗氧量从10 ml/kg/min（+/-2.5）增加到13 ml/kg/min（+/-23）（p < 0.0005）。患者报告呼吸困难显著缓解，医学研究理事会评分平均从3.4降至1.8。
We prospectively studied the surgical aspects, functional results, and complications of video-assisted bilateral thoracoscopic volume reduction surgery in patients with severe diffuse pulmonary emphysema. Methods: Fifteen men and five women with a mean age of 64 years (range 42 to 78 years) whose daily activity was substantially impaired by severe airflow obstruction and hyperinflation underwent thoracoscopic volume reduction surgery, The prospective preoperative assessment and postoperative assessment at 3 months included (1) pulmonary function studies, (2) grading of dyspnea, and (3) exercise performance; pulmonary function tests were also performed immediately before discharge from the hospital, Results: There was no perioperative mortality. All patients left the hospital after a median stay of 15 days (6 to 27 days). Only seven patients had a prolonged chest tube drainage time (>7 days), At 3 months the mean (+/- standard deviation) forced expiratory volume,in 1 second had improved by 42% (+/-3.8%), from 0.80 L (+/-0,23) to 1.09 L (+/-0,28) (p < 0.001); residual volume had decreased from 5.8 L (+/-1,5) to 4.4 L (+/-1.0) (p, < 0.001). Shortly before discharge the forced expiratory volume in 1 second was already 1.10 L (+/-0,26). The median 12-minute walking distance increased from 495 m (35 to 790 m) to 688 m (175 to 1035 m) (p < 0.001) and the mean maximal oxygen consumption from 10 ml/kg per minute (+/-2.5) to 13 ml/kg per minute (+/-23) (p < 0.0005). The patients reported a substantial relief of dyspnea with a mean decrease in the Medical Research Council score from 3.4 to 1.8.