Harefield Hospital, Uxbridge, Middlesex, UK.
Eur J Cardiothorac Surg. 2012 Sep;42(3):410-3. doi: 10.1093/ejcts/ezs086. Epub 2012 Mar 1.
Lung transplantation is an established treatment for patients with advanced emphysema. Double-lung transplantation is favoured to avoid complications following single-lung transplantation, including native lung hyperinflation. Nonetheless, single-lung transplantation continues due to limited donor organ availability. The aim of this study was to evaluate the pre-operative assessment, surgical techniques and outcomes in patients undergoing lung volume reduction surgery for native lung hyperinflation.
Eight patients underwent lung volume reduction surgery for native lung hyperinflation between October 2008 and April 2011. Symptoms, pre-operative evaluation, peri-operative morbidity, length of stay, pulmonary function and survival were examined. The mean follow-up was 17 months.
Participants underwent high resolution CT and bronchoscopy with transbronchial biopsy and bronchial washings to exclude alternative causes for deterioration in pulmonary function tests. V/Q scan was performed to assess the contribution of each lung to overall function. Measurement of inspiratory airflow resistance in each lung was performed in one case. Seven patients underwent multiple wedge resections and one underwent bilobectomy. All patients survived to hospital discharge, and mean length of stay was 13.9 days. Functional improvement was demonstrated in all cases at follow-up, with a mean percentage increase of 29.3% in forced expiratory volume in one second and 21.6% in forced vital capacity. Symptomatic improvement was also reported by all patients post-operatively.
Lung volume reduction surgery for native lung hyperinflation is an effective treatment strategy with an acceptable level of surgical risk. Patient selection, however, remains vital. The non-anatomical multiple wedge excision technique used here was as effective as anatomical lung volume reduction surgery used in other series. With regard to pre-operative assessment, the measurement of single-lung inspiratory airflow resistance is of particular interest. We feel that this may provide an additional method of differentiating between native lung hyperinflation and obliterative bronchiolitis prior to surgery, thus improving patient selection.
肺移植是治疗晚期肺气肿患者的一种成熟治疗方法。与单肺移植相比，双肺移植可避免单肺移植后出现的并发症，包括原生肺过度充气。尽管如此，由于供体器官的有限可用性，单肺移植仍在继续。本研究旨在评估接受原生肺过度充气肺减容手术的患者的术前评估、手术技术和结果。
2008 年 10 月至 2011 年 4 月期间，8 例患者因原生肺过度充气行肺减容术。检查症状、术前评估、围手术期发病率、住院时间、肺功能和生存率。平均随访时间为 17 个月。
参与者接受高分辨率 CT 和支气管镜检查，包括经支气管活检和支气管灌洗，以排除肺功能检查恶化的其他原因。V/Q 扫描用于评估每个肺对整体功能的贡献。在一个病例中测量了每个肺的吸气气流阻力。7 例患者行多楔形切除术，1 例患者行双叶切除术。所有患者均存活至出院，平均住院时间为 13.9 天。所有病例在随访时均显示功能改善，用力呼气量的平均百分比增加 29.3%，用力肺活量增加 21.6%。所有患者术后均报告症状改善。
针对原生肺过度充气的肺减容手术是一种有效的治疗策略，手术风险可接受。然而，患者选择仍然至关重要。这里使用的非解剖性多楔形切除术与其他系列中使用的解剖性肺减容手术一样有效。就术前评估而言，单肺吸气气流阻力的测量特别有意义。我们认为，这可能为手术前区分原生肺过度充气和闭塞性细支气管炎提供一种额外的方法，从而改善患者选择。
