Beckers Frank, Lange Nadine, Koryllos Aris, Picchioni Fabrizio, Windisch Wolfram, Stoelben Erich
Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Lehrstuhl für Thoraxchrirugie der Privaten Universität Witten/Herdecke, Köln, Germany.
Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Lehrstuhl für Pneumologie und Beatmungsmedizin der Privaten Universität Witten/Herdecke, Köln, Germany.
Thorac Cardiovasc Surg. 2016 Jun;64(4):336-42. doi: 10.1055/s-0034-1395989. Epub 2014 Dec 23.
Background Lung volume reduction surgery (LVRS) is a well-established treatment option for pulmonary emphysema, but the most advantageous technical approach remains debatable. Methods Short- and long-term outcomes were comparably assessed in pulmonary emphysema patients who underwent unilateral LVRS with either lobe or sublobe (segment or wedge) resection. Patients were consecutively enrolled in the study after careful conventional and computer-based definition of the target region. Results A total of 36 patients with a mean age of 62.1 ± 8.9 years (range, 41-79 years) were recruited. Video-assisted thoracoscopy (VATS) was performed in 33 patients, while 3 patients with additional early-stage lung cancer received anterolateral thoracotomy. Surgery duration was longer for lobectomy (median 93 minutes, range 44-168 minutes) as compared with sublobe resection (median 52 minutes, range 25-131 minutes; p = 0.0007), but complication rates were similar. After 90 days postsurgery, mortality was zero and lung function improved to a similar degree in both the groups. After 1 year, total lung capacity (TLC) was still reduced by 17.2 ± 20.6% predicted as compared with the baseline values for lobe resection, while TLC was increased by 12.1 ± 14.5% predicted for sublobe resection. In addition, the 6-minute walking distance improved following LVRS, with slightly better results in lobe resection patients. Conclusions By careful definition of the target region, unilateral VATS-LVRS with lobe resection in severely affected pulmonary emphysema patients is a safe procedure that is superior to unilateral sublobe VATS resection in terms of improving long-term 1-year lung hyperinflation. Therefore, unilateral VATS lobe resection is a promising treatment approach that should be further evaluated by randomized controlled trials.
背景 肺减容手术（LVRS）是治疗肺气肿的一种成熟的治疗选择，但最有利的技术方法仍存在争议。方法 对接受单侧LVRS肺叶或肺叶下（节段或楔形）切除的肺气肿患者的短期和长期结局进行了比较评估。在通过传统和基于计算机的仔细定义目标区域后，患者连续纳入研究。结果 共招募了36例平均年龄为62.1±8.9岁（范围41 - 79岁）的患者。33例患者接受了电视辅助胸腔镜手术（VATS），而3例合并早期肺癌的患者接受了前外侧开胸手术。与肺叶下切除（中位时间52分钟，范围25 - 131分钟；p = 0.0007）相比，肺叶切除术的手术时间更长（中位时间93分钟，范围44 - 168分钟），但并发症发生率相似。术后90天，两组死亡率均为零，肺功能改善程度相似。1年后，与肺叶切除的基线值相比，肺总量（TLC）仍比预计值降低了17.2±20.6%，而肺叶下切除的TLC比预计值增加了12.1±14.5%。此外，LVRS后6分钟步行距离有所改善，肺叶切除患者的结果略好。结论 通过仔细定义目标区域，对严重肺气肿患者进行单侧VATS-LVRS肺叶切除是一种安全的手术，在改善长期（1年）肺过度充气方面优于单侧肺叶下VATS切除。因此，单侧VATS肺叶切除是一种有前景的治疗方法，应通过随机对照试验进一步评估。
