Tacconi Federico, Pompeo Eugenio, Forcella Daniele, Marino Mario, Varvaras Dimitrios, Mineo Tommaso C
Thoracic Surgery Division, Emphysema Center, Policlinico Tor Vergata University, Rome, Italy.
Ann Thorac Surg. 2008 Apr;85(4):1171-7. doi: 10.1016/j.athoracsur.2007.12.009.
Optimal management of emphysematous patients who have lost the benefits achieved after lung volume reduction surgery is a clinical dilemma. We have hypothesized that in stringently selected instances, lung volume reduction reoperations might be considered as a salvage surgical treatment. We sought to analyze the results of a series of patients undergoing lung volume reduction reoperations after successful bilateral lung volume reduction surgery.
Between January 2000 and April 2006, 17 patients (mean age, 66 +/- 3 years) with radiologic evidence of distinct regional lung hyperinflation underwent lung volume reduction reoperations. Surgical procedures entailed completion lobectomy in 7 patients, nonanatomic resection of lung target areas were performed in 5 patients under general anesthesia with one-lung ventilation, and awake lung plication was performed in 5 patients under sole epidural anesthesia. Follow-up at 6 and 12 months was complete in all survivors.
Mean operative time was 100 +/- 12 minutes. Two patients (11.7%) died perioperatively of adult respiratory distress syndrome. Hospital stay was 9 +/- 2 days. Significant improvements occurred for up to 12 months in forced expiratory volume in 1 second (FEV(1); p < 0.001), forced vital capacity (p < 0.002), residual volume (p < 0.001), 6-minute walk test (p < 0.001), and modified Medical Research Council dyspnea index (p < 0.001). At 6-months, improvements in FEV(1) were greater than 200 mL in 11 patients and correlated with the postoperative reduction in residual volume (r = -0.62, p = 0.01); baseline residual volume was inversely correlated with the degree of improvement in the dyspnea index (r = -0.54, p = 0.03).
Lung volume reduction reoperations can offer significant clinical improvement to stringently selected patients who have lost the clinical benefit achieved after lung volume reduction surgery.
对于那些已失去肺减容手术所带来益处的肺气肿患者，最佳治疗方案是一个临床难题。我们推测，在经过严格筛选的病例中，肺减容再次手术可被视为一种挽救性外科治疗方法。我们试图分析一系列在双侧肺减容手术成功后接受肺减容再次手术患者的结果。
在2000年1月至2006年4月期间，17例（平均年龄66±3岁）有明显区域性肺过度充气影像学证据的患者接受了肺减容再次手术。手术方式包括7例行全肺叶切除术，5例在全身麻醉单肺通气下对肺靶区进行非解剖性切除，5例在单纯硬膜外麻醉下进行清醒肺折叠术。所有幸存者均完成了6个月和12个月的随访。
平均手术时间为100±12分钟。2例患者（11.7%）围手术期死于成人呼吸窘迫综合征。住院时间为9±2天。术后12个月内，第1秒用力呼气容积（FEV₁；p<0.001）、用力肺活量（p<0.002）、残气量（p<0.001）、6分钟步行试验（p<0.001）和改良医学研究委员会呼吸困难指数（p<0.001）均有显著改善。在6个月时，11例患者的FEV₁改善超过200 mL，且与术后残气量减少相关（r = -0.62，p = 0.01）；基线残气量与呼吸困难指数改善程度呈负相关（r = -0.54，p = 0.03）。
对于那些已失去肺减容手术临床益处且经过严格筛选的患者，肺减容再次手术可带来显著的临床改善。
