Indication and Comparison of Surgical Therapy for Pulmonary Emphysema

肺气肿一直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，美国有报道称手术治疗肺气肿可改善呼吸功能和症状（1 -4）。但目前尚不清楚哪种方法和指示更好。此外，日本肺气肿患者很少有手术指示。因此，我们在国内对这些问题进行了研究和分析。根据以下标准选择患者：所有候选人都进行了肺部评估。（患者和方法）适应证：尽管有最大的医疗管理。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。胸片显示肺过度膨胀，膈变平。计算机断层扫描（CT）必须是均匀的。放射性核素通气和灌注（V/Q）肺扫描也被用来确认非均匀性肺气肿。肺功能研究：所有患者均进行标准肺功能检查和动脉血气检查。采用体体积描记术测量胸气量功能储备容量。总肺活量（TLC）。和剩余容积（RV）。测定了一氧化碳的单次呼吸扩散能力。肺动脉导管（Swan-Ganz）检测循环功能。术后功能损害程度的变化在6个月的研究中确定。手术方法：所有患者均采用左侧双腔管全麻（异氟醚）。采用侧卧位的患者进行胸腔镜手术。套管针及胸腔镜经腋中线第6肋间隙放置。另外做3个1 ~ 2 cm的切口用于内镜吻合器和器械。双边程序。患者转至对侧卧位。术前肺部CT扫描和通气/灌注扫描用于确定严重肺气肿肺的切除目标区域。平卧位胸骨正中切开术。经仪器。统计分析：除非另有说明，数据以平均值*平均值的标准误差（SEM）表示。组间比较采用双尾配对学生t检验，以p<0.05为显著性。采用pearson’s x2统计对各VRS技术进行分析。（结果）1术前和术后功能数据总结如下。双边程序。正中或胸腔镜。单侧手术患者FVE1.0和RV的改善明显更大。双侧手术对FlV1.0的改善是单侧手术的两倍。还有双边组织。另一项FRC和TLC较术前基线测量明显下降。2术中出血量明显减少

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