Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois.
Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, Illinois.
Ann Thorac Surg. 2019 Sep;108(3):866-872. doi: 10.1016/j.athoracsur.2019.03.089. Epub 2019 May 2.
Lung volume reduction surgery (LVRS) is the definitive treatment for patients with severe emphysema. There is still a need for long-term data concerning the outcomes of this procedure. This study presents long-term longitudinal data on LVRS including correlation of quality of life (QOL) with pulmonary function testing metrics and includes additional analysis of patients with heterogeneous and homogeneous emphysema.
Retrospective analysis of data collected from patients undergoing LVRS over a 9-year period at a single center was performed (N = 93). Pulmonary function and 6-minute walk tests as well as QOL questionnaires were administered before and 1 year after surgery. Descriptive statistics were reported for clinical outcomes and QOL indices. Wilcoxon signed-rank tests were used to examine changes from baseline to end of 1-year follow-up. Spearman correlation coefficients were used to evaluate relationships between clinical and QOL outcomes.
At 1-year post surgery, mean forced vital capacity (46%, P ≤ .0001), forced expiratory volume (43%, P ≤ .0001), diffusing capacity of the lungs for carbon monoxide (16%, P ≤ .0001), and 6-minute walk distance (20%, P ≤ .0001) were increased from baseline, while residual volume decreased (23%, P ≤ .0001). There was a positive correlation between changes in QOL and forced expiratory volume, forced vital capacity, and, 6-minute walk distance. Patients having heterogeneous disease had greater improvements in forced expiratory volume, forced vital capacity, residual volume, and diffusing capacity of the lungs for carbon monoxide, and greater QOL compared with patients with homogeneous disease.
LVRS continues to be a valuable treatment option for patients with advanced emphysema with reproducible improvements in clinical and QOL metrics. Careful patient selection and optimization prior to surgery are crucial to successful outcomes.
肺减容术（LVRS）是治疗严重肺气肿患者的确定性治疗方法。仍需要有关该手术结果的长期数据。本研究提供了关于 LVRS 的长期纵向数据，包括生活质量（QOL）与肺功能测试指标的相关性，并对异质性和均质性肺气肿患者进行了额外分析。
对单中心 9 年内接受 LVRS 的患者的数据进行回顾性分析（N=93）。在手术前和手术后 1 年进行肺功能和 6 分钟步行测试以及 QOL 问卷。报告临床结果和 QOL 指数的描述性统计数据。使用 Wilcoxon 符号秩检验检查从基线到 1 年随访结束时的变化。使用 Spearman 相关系数评估临床和 QOL 结果之间的关系。
手术后 1 年，平均用力肺活量（46%，P≤.0001）、用力呼气量（43%，P≤.0001）、一氧化碳弥散量（16%，P≤.0001）和 6 分钟步行距离（20%，P≤.0001）从基线增加，而残气量减少（23%，P≤.0001）。QOL 变化与用力呼气量、用力肺活量和 6 分钟步行距离呈正相关。与均质性疾病患者相比，异质性疾病患者的用力呼气量、用力肺活量、残气量和一氧化碳弥散量改善更大，QOL 更高。
LVRS 仍然是治疗晚期肺气肿患者的有价值的治疗选择，可重复改善临床和 QOL 指标。手术前仔细选择和优化患者对于获得成功的结果至关重要。
