Safety and efficacy of median sternotomy versus video-assisted thoracic surgery for lung volume reduction surgery
Safety and efficacy of median sternotomy versus video-assisted thoracic surgery for lung volume reduction surgery
复制标题
DOI：
10.1016/j.jtcvs.2003.11.025
复制
发表时间：
2004-05-01
影响因子：
6
通讯作者：
Al-Amin, A
中科院分区：
文献类型：
--
作者：
Fishman, AP;Bozzarello, BA;Al-Amin, A
背景资料：国家肺气肿治疗试验，一项随机试验比较肺减容手术与药物治疗严重肺气肿，包括随机和非随机比较正中胸骨切开术和电视胸腔镜方法肺减容surgery.Methods：肺减容手术进行正中胸骨切开术仅在8个中心和电视胸腔镜仅在3个中心; 6家临床试验机构随机分配了肺减容手术的入路。死亡率，发病率，功能状态，和costs.Results：在非随机比较，359例患者接受肺减容手术正中胸骨切开术，152例患者接受肺减容手术电视胸腔镜。正中胸骨切开术的90天死亡率为5.9%，电视辅助胸腔镜手术的90天死亡率为4.6%（P = 0.67）。正中胸骨切开术的总死亡率为0.08例死亡/人-年，电视胸腔镜手术的总死亡率为0.10例死亡/人-年（电视胸腔镜手术-胸骨切开术风险比为1.18; P = 0.42）。两种方法的并发症发生率较低，无统计学差异。正中胸骨切开术的中位住院时间长于电视胸腔镜术（10 vs 9天; P = 0.01）。术后30天，70.5%的正中胸骨切开术患者和80.9%的电视辅助胸腔镜患者独立生活（P = 0.02）。12个月和24个月时，正中胸骨切开术和电视辅助胸腔镜手术的功能结局相似。胸腔镜手术的手术费用、相关住院时间和术后6个月的费用均低于正中胸骨切开术（两种情况下P <0.01）。相似的结果指出，随机comparation.Conclusions：发病率和死亡率肺减容手术后，电视胸腔镜或正中胸骨切开术，功能的结果。电视胸腔镜肺减容术比正中胸骨切开术更早恢复，成本更低。
Background: The National Emphysema Treatment Trial, a randomized trial comparing lung volume reduction surgery with medical therapy for severe emphysema, included randomized and nonrandomized comparisons of the median sternotomy and video-assisted thoracoscopic approaches for lung volume reduction surgery.Methods: Lung volume reduction surgery was performed by median sternotomy only at 8 centers and video-assisted thoracoscopy only at 3 centers; 6 centers randomized the approach to lung volume reduction surgery. Mortality, morbidity, functional status, and costs were assessed.Results: In the nonrandomized comparison, 359 patients received lung volume reduction surgery by median sternotomy, and 152 patients received lung volume reduction surgery by video-assisted thoracoscopy. The 90-day mortality was 5.9% for median sternotomy and 4.6% for video-assisted thoracoscopy (P = .67). Overall mortality was 0.08 deaths per person-year for median sternotomy and 0.10 deaths per person-year for video-assisted thoracoscopy (video-assisted thoracoscopy-methan sternotomy risk ratio, 1.18; P = .42). Complication rates were low and not statistically different for the 2 approaches. The median hospital length of stay was longer for median sternotomy than for video-assisted thoracoscopy (10 vs 9 days; P = .01). By 30 days after surgery, 70.5% of median sternotomy patients and 80.9% of video-assisted thoracoscopy patients were living independently (P = .02). Functional outcomes were similar for median sternotomy and video-assisted thoracoscopy at 12 and 24 months. Costs for the operation and the associated hospital stay and costs in the 6 months after surgery were both less for video-assisted thoracoscopy than for median sternotomy (P < .01 in both cases). Similar results were noted for the randomized comparison.Conclusions: Morbidity and mortality were comparable after lung volume reduction surgery by video-assisted thoracoscopy or median sternotomy, as were functional results. The video-assisted thoracoscopic approach to lung volume reduction surgery allowed earlier recovery at a lower cost than median sternotomy.