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，没有手术治疗。近年来，美国有报道称肺气肿手术治疗能改善呼吸功能和症状(1-4例)。但目前还不清楚哪种方法和指标更好。此外，日本很少有肺气肿患者的手术指征。因此，我们对这些问题在我国进行了研究和分析。根据以下标准选择患者：所有患者均由肺科医生进行评估。(病人和方法)适应症：给予最大限度的医疗管理。所有患者都有明显的症状，通过呼吸困难指数和生活质量评估来衡量。戒烟。胸部X线片显示肺过度膨胀，横隔膜变平。计算机断层扫描(CT)必须是不均匀的。放射性核素通气和灌注(V/Q)肺扫描也用于确认异质性p…更像是肺气肿。肺功能研究：所有患者均接受标准肺功能测试和动脉血气分析。采用体体积描记仪测定胸气量、功能储备容量。肺总容量(TLC)。和残气量(RV)。还测量了一氧化碳(DCLO)的单次呼吸扩散容量。采用Swan-Ganz肺动脉导管测定循环功能。在为期6个月的研究中确定手术后功能损害程度的变化。手术步骤：所有患者均使用左侧双腔导管进行全身麻醉(异氟醚)。胸腔镜术是在患者处于侧卧位时进行的。套管针和胸腔镜均经腋中线第6肋间置入。为内窥镜吻合器和器械另外做了3个1~2 cm的切口。双边程序。患者转向对侧卧位。术前行肺部CT扫描和肺通气/灌注扫描，以确定重度肺气肿的手术切除范围。胸骨正中切开术采用仰卧位。胸腔镜术器械。统计分析：除非另有说明，数据以平均数*平均数的标准误差(SEM)表示。两组之间的差异用双尾配对t检验进行比较，p&lt；0.05被认为是显著的。每种VRS技术均采用Peason的x~2统计量进行分析。(结果)1术前、术后功能数据总结如下。双边程序。正中或胸腔镜检查。FVE1.0和RV的改善在单侧Teral手术的患者中明显更大。双侧手术对FlV1.0的改善是单侧手术的两倍。和双边团体。另一组FRC和TLC较术前显著降低。2术中失血量明显减少

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