Nezu K, Kawaguchi T, Kimura M, Yasukawa M, Kushibe K, Taniguchi S, Yoshikawa M
Department of Surgery III, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
Jpn J Thorac Cardiovasc Surg. 2001 Sep;49(9):552-6. doi: 10.1007/BF02913531.
We studied the short-term effect of lung volume reduction surgery on nutritional status including body composition and the relationship between preoperative nutritional status and postoperative morbidity.
Subjects were 28 patients with emphysema who underwent bilateral thoracoscopic lung volume reduction surgery (23 simultaneously, 5 staged). Functional tests, body weight, and body composition were measured before and 6 months after surgery. Fat-free mass and fat mass were assessed by bioelectrical impedance analysis.
FEV1.0 improved 35.2% following surgery and maximal oxygen uptake 23.8%. Body weight and fat-free mass increased significantly after surgery, while fat mass was unchanged. Of the 23 undergoing simultaneous bilateral lung volume reduction surgery, 8 had major complications-3 required additional surgery to close air leaks, 3 required mechanical ventilation (> 72 hrs), and 2 developed postoperative infection. The preoperative percentage of ideal body weight and fat-free mass was significantly higher among patients without major complications.
Bilateral lung volume reduction surgery increases fat-free mass and provides functional improvement for underweight patients with severe emphysema. We found fat-free mass and body weight to be good predictors of unacceptable postoperative complications following bilateral lung volume reduction surgery.
我们研究了肺减容手术对营养状况（包括身体组成）的短期影响，以及术前营养状况与术后发病率之间的关系。
研究对象为28例接受双侧胸腔镜肺减容手术的肺气肿患者（23例同期手术，5例分期手术）。在手术前和术后6个月测量功能测试、体重和身体组成。通过生物电阻抗分析评估去脂体重和脂肪量。
术后第一秒用力呼气量（FEV1.0）提高了35.2%，最大摄氧量提高了23.8%。术后体重和去脂体重显著增加，而脂肪量未改变。在23例同期进行双侧肺减容手术的患者中，8例出现严重并发症——3例需要额外手术以封闭漏气，3例需要机械通气（超过72小时），2例发生术后感染。无严重并发症患者术前的理想体重百分比和去脂体重显著更高。
双侧肺减容手术可增加去脂体重，并为重度肺气肿体重不足的患者提供功能改善。我们发现去脂体重和体重是双侧肺减容手术后不可接受的术后并发症的良好预测指标。
