Indication and Comparison of Surgical Therapy for Pulmonary Emphysema

肺气肿手术治疗的适应证及比较

• 批准号: 09671402
• 负责人: IWASAKI Akinori
• 金额: $ 2.05万
• 依托单位: Fukuoka University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 1997
• 资助国家: 日本
• 起止时间: 1997 至 1998
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-09671402/
• 关键词: Pulmonary Emphysema; Surgical Therapy; Volume Reduction Sergery; Thoracoscope; Median Sternotomy; Volume reduction surgery; Volume reduction; 胸腔鏡手術

Pulmonary emphysema has been considered to be a irreversible disease and thought to be no surgical therapy only except lung transplantation. Recently surgical approach for pulmonary emphysema has reports in improvement of respiratory function and symptoms at United State(1 -4). But it is not clear which is better a pproach and indication. Furthermore rarely surgical indicate to the patients with emphyseme in Japan. So we study and analyze of these points in our country. Patients were selected according to the following criteria : All canditates were evaluated pulmonogist. (Patients and methods ) Indication : Dispite maximal medical management. all patients had marked symptoms, as measured by a dyspnea index and quality-of-life assessment. Smoking cessation. Chest roeotgenograms showed hyperinflated lung with flattening of the diaphragms. Computed tomography (CT) had to be helerogeneous. Radionuclide ventilation and perfusion(V/Q) lung scans were also used to confirm the heterogeneous p … More attern of emphysema. Lung function studies : All patients underwent standerd pulmonary function tests and arterial blood gases. Body plethysmography was used to mesure thoracic gas volumes function reserve cpacity. total lung capacity (TLC). and residual volume(RV). The single breath diffusion capacity for carbon monoxide(DCLO) were also measured. Pulmonary artery caiheter(Swan-Ganz) were used for circulatory function. Change in the degree of functional impairment after surgery was determined at6- month study. Operative procedures : All patients underwent general anesthesia (isofiurane) using a left-sided double-lumen tube. Thoracoscopic procedures were performed with patients in the lateral decubitus position. The trocar and thoracoscope were placed through the 6th intercostal space in the middle axillary line. Three additional 1 to 2 cm incisions were made for the endoscopic stapler and instruments. Bilateral procedures. patients were turned to the contralateral decubitus position. The preoperative lung CT scan and ventilation/perfuion scan were used to identify areas of severely emphysematous lung targeted for resection. Median sternotomy were performed in the supine position without. thoracoscopic instruments. Stastical analysis : Data are presented as mean *standard error of the mean(SEM) unless otherwise specifield. Differences between groups are compared with two-tailed paired sutudent's t test, with p<0.05 considered significant. peason's x 2 stasties were used to analyze in each VRS technique. (Results) 1 The PreOPerative and postoperative functional data are summarized as follow. Bilateral procedures. median or thoracoscope. the improvement in FVE1.0 and RV were signiticantly greater for patients with unila teral procedure. Bilateral procedures produced double improvement in FlV1.0 than unilateral. And bilateral groups. another FRC and 'TLC had significantly decreased from the preoperative baseline measurement. 2 Blood loss at operation was great significa Less

肺气肿被认为是一种不可逆转的疾病，除了肺移植外，没有其他手术治疗方法。最近，在美国，有报道称肺气肿的手术方法改善了呼吸功能和症状（1 - 4）。但目前尚不清楚哪种方法和适应证更好。此外，在日本很少有肺气肿患者的手术指征。因此，我们对我国的这些问题进行了研究和分析。根据以下标准选择患者：所有候选人均由肺病学家进行评估。（患者和方法）适应症：分散的最大医疗管理。通过呼吸困难指数和生活质量评估，所有患者都有明显的症状。戒烟。胸部X线片显示肺过度充气，横膈膜变平。计算机断层扫描（CT）必须是异质性的。放射性核素肺通气和灌注（V/Q）扫描也被用来证实异质性肺栓塞。 ...更多信息 肺气肿的症状肺功能检查：所有患者均行标准肺功能检查和动脉血气分析。用体容积描记法测定胸气量、功能储备容量。肺总容量（TLC）。剩余容量（RV）。同时测定一氧化碳单次呼吸弥散量（DCLO）。肺动脉导管（Swan-Ganz）检测循环功能。在6个月的研究中确定了手术后功能损害程度的变化。手术程序：所有患者均使用左侧双腔插管进行全身麻醉（异氟烷）。患者在侧卧位进行胸腔镜手术。套管针和胸腔镜通过腋中线第6肋间隙置入。另外为内镜吻合器和器械做了3个1 - 2 cm的切口。双边程序。患者均转为健侧卧位。术前肺部CT扫描和通气/灌注扫描用于确定切除的重度肺气肿肺区域。胸骨正中切开术在仰卧位进行，没有。胸腔镜器械。统计分析：数据表示为平均值 * 平均值的标准误差（SEM），除非另有说明。用双尾配对sutudent t检验比较组间差异，认为p <0.05是显著的。在每种VRS技术中，使用peason的x2统计进行分析。（结果）1手术前后功能数据如下。双边程序。正中或胸腔镜检查。单侧手术组FVE1.0和RV改善明显。双侧手术使FlV1.0比单侧手术提高一倍。和双边团体。另一个FRC和TLC较术前基线测量值显著降低。2术中出血量明显减少

项目成果

岩崎昭憲、白日高歩: "Volume reducttion surgery-肺気腫への治療効果" 医学のあゆみ. 180. 10. 660-661 (1997)

Akinori Iwasaki、Takaho Hakuhi：“减容手术-对肺气肿的治疗效果”《医学史》180. 10. 660-661 (1997)。

岩崎昭憲、吉永康照 他: "肺気腫の手術手技、適応 : 新たなる治療法も含めて" 日本胸部疾患学会雑誌. 34. 9-11 (1997)

Akinori Iwasaki、Yasuteru Yoshinaga 等人：“肺气肿的手术技术和适应症：包括新的治疗方法”日本胸科疾病学会杂志 34. 9-11 (1997)。

白日高歩: "慢性肺気腫の外科療法とその適応" 総合臨床. 46. 11. 31-32 (1997)

Takaho Hakubi：“慢性肺气肿的手术治疗和适应症”一般临床实践。 46. 11. 31-32 (1997)

Iwasaki, A., Shirakusa, T.: "Volume reduction surgery" Igakunoayumi. 180(10). 660-661 (1997)

Iwasaki, A.、Shirakusa, T.：“减容手术”Igakunoayumi。

岩崎昭憲、白日高歩: "肺気腫に対する外科治療-VRSでは肺をどれだけ取るか-" 呼吸と循環. 45. 9. 861-864 (1997)

Akinori Iwasaki，Takaho Hakuhi：“肺气肿的手术治疗 - 应该用 VRS 切除多少肺？” 45. 9. 861-864 (1997)