Behrsin Rodolfo Fred, da Silva Junior Cyro Teixeira, Gabetto José Manoel, Lima Oriane de Almeida Santana
Universidade Federal Fluminense, Niterói, Rio de Janeiro, RJ, Brazil.
Rev Assoc Med Bras (1992). 2003 Jul-Sep;49(3):274-7. doi: 10.1590/s0104-42302003000300031. Epub 2003 Nov 5.
Chronic Obstructive Pulmonary Disease (CPOD) is an important problem in Brazil and other countries. The clinical treatment of ambulatory patients is now reasonably standardized. Lung volume reduction surgery (LVRS) is an alternative of surgical treatment of emphysema (aside from lung transplantation).
The aim of this study was to analyse patient selection criteria for LVRS.
This study was carried out using a sample of 31 patients referred to and given assistance to at the Smoking and Chronic Obstructive Pulmonary Disease Outpatient Ward Antonio Pedro Hospital, who were evaluated to check whether or not they could be eligible for LVRS. Aiming at evaluating the major criteria for eligibility for LVRS, the patients underwent a protocol including standardized anamnesis and physical examination, spirometry with maximum inspiratory and expiratory flow volume curves associated with post-bronchodilatator test, room air arterial blood gases, a six-minute walking test, plain chest roentgenograms and left lateral chest roentgenograms, high-resolution chest computed tomographic scans and lung perfusion scans. Statistical analysis was conducted with description of data proportions.
Contraindications to surgery included chronic bronchitis (29% or nine patients), forced expiratory volume in one second (FEV 1) more than 80 percent predicted (13% or four patients), negative consent for surgery (10% or three patients), fibrosis pattern, severe depression and bronchiectasis (two patients each one), solitary pulmonary nodule, severe obesity, severe bullous emphysema, pulmonary hipertension, pulmonary resection history, current cigarette smoking, diffuse emphysema with alpha-1-antitrypsin deficiency and severe cardiac disease (one patient each). Indication. One selected patient with severe symptoms of emphysema met criteria for LVRS (bilateral superior lobe heterogeneous pattern of emphysema on chest computed tomography and lung perfusion scan).
Chronic bronchitis was the major isolated factor to contraindicate LVRS. Most patients who fit the criteria for the surgery performance refused to undergo the LVRS for fear of the surgery and after pulmonary rehabilitation. The most important criteria for LVRS is bilateral superior lobe heterogeneous pattern of emphysema.
慢性阻塞性肺疾病（COPD）在巴西和其他国家都是一个重要问题。目前，非卧床患者的临床治疗已基本标准化。肺减容手术（LVRS）是肺气肿的一种手术治疗选择（除肺移植外）。
本研究旨在分析LVRS的患者选择标准。
本研究以安东尼奥·佩德罗医院吸烟与慢性阻塞性肺疾病门诊病房转诊并接受治疗的31例患者为样本，评估他们是否符合LVRS的条件。为了评估LVRS的主要入选标准，患者接受了一系列检查，包括标准化问诊和体格检查、测量最大吸气和呼气流量-容积曲线并进行支气管扩张试验后的肺量计检查、室内空气动脉血气分析、六分钟步行试验、胸部正位片和左侧位胸片、高分辨率胸部计算机断层扫描和肺灌注扫描。采用数据比例描述进行统计分析。
手术禁忌证包括慢性支气管炎（29%，即9例患者）、一秒用力呼气容积（FEV1）超过预测值的80%（13%，即4例患者）、手术同意书为阴性（10%，即3例患者）、纤维化模式、严重抑郁症和支气管扩张（各2例患者）、孤立性肺结节、严重肥胖、严重大疱性肺气肿、肺动脉高压、有肺切除史、目前仍吸烟、伴有α-1抗胰蛋白酶缺乏的弥漫性肺气肿和严重心脏病（各1例患者）。适应证：1例有严重肺气肿症状的入选患者符合LVRS标准（胸部计算机断层扫描和肺灌注扫描显示双侧上叶肺气肿呈不均匀模式）。
慢性支气管炎是LVRS的主要独立禁忌因素。大多数符合手术标准的患者因害怕手术和肺康复后而拒绝接受LVRS。LVRS最重要的标准是双侧上叶肺气肿呈不均匀模式。
