Surgery for predominant lesion in nonlocalized bronchiectasis
Surgery for predominant lesion in nonlocalized bronchiectasis
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非局限性支气管扩张的主要病变的手术
DOI：
10.1016/j.jtcvs.2016.12.004
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发表时间：
2017-04-01
影响因子：
6
通讯作者：
Zhang, Peng
中科院分区：
文献类型：
--
作者：
Dai, Jie;Zhu, Xinsheng;Zhang, Peng
目的：非局限性支气管扩张患者很常见;然而，关于该患者人群的手术干预信息很少。本研究的目的是评估症状的反应和安全性的解剖切除的主要病变通过使用肺叶切除术的管理非局限性bronchiectasis.Methods：我们回顾了37例连续患者的病历谁接受肺叶切除术通过开胸非局限性支气管扩张症在2010年和2013年之间。主要手术指征为非局限性支气管扩张伴一个主要病变、药物治疗失败和足够的心肺储备。通过术前计算机断层扫描和/或支气管镜检查确定主要病变。术前症状与术后症状进行了比较，并通过使用配对techniques.Results进行分析：患者的平均年龄为54.5 +/- 6.4岁。无手术死亡。8例（21.6%）患者发生术后并发症，包括1例脓胸，1例持续漏气，6例轻微一过性并发症，均无需再次手术即可控制。肺叶切除术后，剩余肺中残留支气管扩张区域的中位程度为25%（范围，12.5%-42.9%）。急性感染（5.3 +/- 2.1/年vs 1.8 +/- 2.3/年）和咯血（4.9 +/- 2.8/年vs 1.1 +/- 0.7/年）的频率显著降低，痰量也减少（37.1 +/- 3.4 mL/天vs 10.7 +/- 4.6 mL/天）。23例（62.2%）患者术后无症状，10例（27.0%）有症状的临床改善，4例（10.8%）没有变化或恶化。结论：肺叶切除术的主要病变是一个安全的程序，在非局限性支气管扩张症的外科治疗，并导致显着缓解症状，良好的满意率。
Objective: Patients with nonlocalized bronchiectasis are encountered commonly; however, there is little information regarding surgical intervention in this patient population. The aim of this study was to evaluate symptomatic response and safety of anatomic resection of the predominant lesion via the use of lobectomy for the management of nonlocalized bronchiectasis.Methods: We reviewed the medical records of 37 consecutive patients who underwent lobectomy via thoracotomy for nonlocalized bronchiectasis between 2010 and 2013. The main surgical indications were nonlocalized bronchiectasis with one predominant lesion, failure of medical treatment, and adequate cardiopulmonary reserve. The predominant lesion was determined by preoperative computed tomography and/or bronchoscopy. Preoperative symptoms were compared with postoperative symptoms and analyzed by the use of paired techniques.Results: The mean patient age was 54.5 +/- 6.4 years. There was no operative mortality. Postoperative complications occurred in 8 (21.6%) patients, including 1 with empyema, 1 with persistent air leak, and 6 with minor transient complications, all of which were manageable without any reoperation. After lobectomy, the median extent of residual bronchiectatic areas in the remaining lungs was 25% (range, 12.5%-42.9%). The frequency of acute infection (5.3 +/- 2.1/ year vs 1.8 +/- 2.3/year) and hemoptysis (4.9 +/- 2.8/year vs 1.1 +/- 0.7/year) decreased significantly and the amount of sputum also decreased (37.1 +/- 3.4 mL/day vs 10.7 +/- 4.6 mL/day). Twenty-three (62.2%) patients were asymptomatic after surgery, 10 (27.0%) were symptomatic with clinical improvement, and 4 (10.8%) had no change or worsened.Conclusions: Lobectomy for the predominant lesion is a safe procedure in the surgical treatment of nonlocalized bronchiectasis and leads to significant relief of symptoms with good rates of satisfaction.