[肺减容手术在肺气肿治疗中的地位如何？]

[What place for lung volume reduction surgery for emphysema?].

作者信息

De Wolf J, Bonnette P, Sage É, Hamid A

机构信息

Service de chirurgie thoracique et transplantation pulmonaire, hôpital Foch, 92150 Suresnes, France.

出版信息

Rev Mal Respir. 2017 Feb;34(2):147-154. doi: 10.1016/j.rmr.2016.05.004. Epub 2016 Jul 18.

DOI:10.1016/j.rmr.2016.05.004

PMID:27444695

Abstract

Lung volume reduction surgery (LVRS) has been part of the management for the treatment of selected emphysematous patients for two decades. In a large randomized American trial (NETT), lung volume reduction surgery was shown to improve overall survival at 5 years as well as exercise capacity and health-related quality of life, especially in cases of upper-lobe-predominant emphysema and low exercise capacity. Inclusion criteria were pretreatment FEV1≤45 %, TLC≥100 %, RV≥150 %, room air resting PaCO≤60mmHg and PaO≥45mmHg. Patients with FEV1≤20 % and either a DLCO<20 % or homogeneous emphysema were at increased risk of mortality following LVRS and should not be considered for this procedure. Despite this evidence base, lung volume reduction surgery is performed infrequently, competing with lung transplantation and new endoscopic volume reduction techniques.

摘要

二十年来，肺减容手术（LVRS）一直是部分特定肺气肿患者治疗方案的一部分。在美国一项大型随机试验（NETT）中，肺减容手术被证明可提高5年总生存率，以及运动能力和与健康相关的生活质量，尤其是在上叶为主型肺气肿且运动能力较低的病例中。纳入标准为治疗前第一秒用力呼气容积（FEV1）≤45%、肺总量（TLC）≥100%、残气量（RV）≥150%、静息状态下室内空气时动脉血二氧化碳分压（PaCO）≤60mmHg以及动脉血氧分压（PaO）≥45mmHg。第一秒用力呼气容积≤20%且一氧化碳弥散量（DLCO）<20%或存在均匀性肺气肿的患者，肺减容手术后死亡风险增加，不应考虑进行该手术。尽管有这些证据基础，但肺减容手术的实施并不频繁，它与肺移植和新的内镜下减容技术存在竞争。