Indication and Comparison of Surgical Therapy for Pulmonary Emphysema

点击翻译按钮获取中文摘要

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