Bloch Konrad E, Georgescu Carmina L, Russi Erich W, Weder Walter
Pulmonary and Thoracic Surgery Division, University Hospital of Zurich, Switzerland.
J Thorac Cardiovasc Surg. 2002 May;123(5):845-54. doi: 10.1067/mtc.2002.120731.
Surgical lung volume reduction improves lung function and dyspnea in advanced emphysema to a variable degree. Because long-term results with this procedure are scant, we prospectively investigated lung function over several years after lung volume reduction surgery with regard to emphysema morphology.
Bilateral video-assisted thoracoscopic lung volume reduction surgery was performed in severely symptomatic patients with marked hyperinflation caused by advanced nonbullous emphysema. Emphysema heterogeneity was visually graded on chest computed tomography. Symptoms and lung function were assessed before the operation and 3, 6, and then every 6 months after the operation.
A total of 115 patients with a median forced expiratory volume in 1 second of 0.73 L (27% of predicted value) underwent lung volume reduction surgery. Follow-up extended over a median of 37 months. Median forced expiratory volume in 1 second significantly increased within 6 months after the operation by 37% in homogeneous (n = 27), by 38% in intermediately heterogeneous (n = 37), and by 63% in markedly heterogeneous emphysema (n = 51, P <.05 vs. other morphologies). Maximal forced expiratory volume in 1 second was reached within 6 months after lung volume reduction surgery and decreased in the first postoperative year by 0.16 L per year in homogeneous, by 0.19 L per year in intermediately heterogenous, and by 0.32 L per year in markedly heterogeneous emphysema (P <.01 vs. other morphologies). The decline in forced expiratory volume in 1 second over subsequent years decelerated according to an exponential decay and was similar for all morphologic types (median annual decrease of 0.09 L [9%]).
Lung volume reduction surgery improves lung function in severe homogeneous and, to an even greater extent, heterogeneous emphysema. Forced expiratory volume in 1 second peaks within 6 months postoperatively. The subsequent decline is most rapid in the first year and slows down in succeeding years according to an exponential decay. Therefore, long-term functional results of lung volume reduction surgery may be more favorable than expected from linear extrapolations of short-term observations.
外科肺减容术在一定程度上可改善晚期肺气肿患者的肺功能和呼吸困难症状。由于该手术的长期结果较少，我们前瞻性地研究了肺减容术后数年的肺功能与肺气肿形态的关系。
对因晚期非大疱性肺气肿导致严重症状且明显肺过度充气的患者实施双侧电视辅助胸腔镜肺减容术。通过胸部计算机断层扫描对肺气肿的异质性进行视觉分级。在手术前以及术后3个月、6个月，随后每6个月评估患者的症状和肺功能。
共有115例患者接受了肺减容手术，其1秒用力呼气容积中位数为0.73L（占预测值的27%）。随访时间中位数为37个月。术后6个月内，均匀型肺气肿（n = 27）患者的1秒用力呼气容积中位数显著增加37%，中度异质型（n = 37）增加38%，显著异质型肺气肿（n = 51）增加63%（与其他形态相比，P <.05）。肺减容术后6个月内达到1秒用力呼气量最大值，术后第一年，均匀型肺气肿患者每年下降0.16L，中度异质型每年下降0.19L，显著异质型肺气肿每年下降0.32L（与其他形态相比，P <.01）。随后几年中，1秒用力呼气容积的下降呈指数衰减减速，且所有形态类型相似（每年中位数下降0.09L [9%]）。
肺减容术可改善严重均匀型肺气肿患者的肺功能，对于异质型肺气肿患者改善程度更大。1秒用力呼气容积在术后6个月内达到峰值。随后的下降在第一年最为迅速，之后数年根据指数衰减减缓。因此，肺减容术的长期功能结果可能比根据短期观察的线性推断更有利。
