Teschler H, Thompson A B, Stamatis G
Ruhrlandklinik, Dept of Respiratory Medicine, Medical Faculty, University of Essen, Germany.
Eur Respir J. 1999 May;13(5):1170-6. doi: 10.1034/j.1399-3003.1999.13e38.x.
Lung volume reduction surgery (LVRS) has emerged as a surgical therapeutic intervention for advanced emphysema. Designed for the relief of dyspnoea, LVRS has been demonstrated to be efficacious in a subset of carefully selected patients. Short-term improvements in dyspnoea are accompanied by improvements in forced expiratory volume in one second ranging 13-96%. Lung volumes likewise improve, with lessening of trapped gas, residual volume, and total lung capacity. Improvements in functional status and quality-of-life measures parallel the improvements in dyspnoea and lung function. One preliminary study suggests that life expectancy after 3 yrs may be improved following LVRS. Many questions regarding lung volume reduction surgery in terms of operative technique, selection of patients, and outcome remain to be answered. Data are available which begin to address some of these issues. Bilateral procedures have greater short-term improvements than unilateral procedures, but the rate of loss of function following the surgery may also be greater. Stapled resection of lung tissue has been demonstrated to be superior to laser ablation. In a majority of reports, outcome is superior in patients with heterogeneous distribution of their emphysema, and patients with alpha1-proteinase inhibitor deficiency emphysema do less well than patients with smoker's emphysema.
肺减容手术（LVRS）已成为晚期肺气肿的一种外科治疗手段。旨在缓解呼吸困难的肺减容手术已被证明在一部分精心挑选的患者中是有效的。呼吸困难的短期改善伴随着一秒用力呼气量13%至96%的改善。肺容量同样得到改善，潴留气体、残气量和肺总量减少。功能状态和生活质量指标的改善与呼吸困难和肺功能的改善同步。一项初步研究表明，肺减容手术后3年的预期寿命可能会提高。关于肺减容手术在手术技术、患者选择和结果方面的许多问题仍有待解答。已有数据开始解决其中一些问题。双侧手术比单侧手术有更大的短期改善，但手术后功能丧失的发生率也可能更高。肺组织的吻合器切除已被证明优于激光消融。在大多数报告中，肺气肿分布不均的患者结果更好，α1-蛋白酶抑制剂缺乏性肺气肿患者的情况不如吸烟性肺气肿患者。
