Venn G E, Williams P R, Goldstraw P
Brompton Hospital, London.
Thorax. 1988 Dec;43(12):998-1002. doi: 10.1136/thx.43.12.998.
Twenty two operations have been performed on 20 patients for the relief of symptoms due to bullous lung disease. Open intubation drainage of the bullae was used in all patients, the technique initially devised by Monaldi for the treatment of intrapulmonary tuberculous abscesses having been modified. Three patients died after surgery. Mortality was associated with low preoperative FEV1 (median 350 ml) and higher preoperative arterial carbon dioxide tension (PaCO2) (median 7.8 kPa). Symptomatic improvement was reported by 16 of the remaining 17 patients and was maintained over a median follow up period of 1.6 years. This was accompanied by objective improvement in lung function with a 22% median improvement in FEV1, an 11% median reduction in total lung capacity, and a 26% median reduction in residual volume. In one patient symptoms were unchanged after surgery. The technique described provides a simple method for decompressing bullae by means of a minimally invasive surgical procedure. It also allows for the treatment of further bullae at a later date by closed intubation under local anaesthetic. It has proved a suitable approach for all but those with the poorest lung function and is now our treatment of choice.
已对20例患者进行了22次手术，以缓解大疱性肺病引起的症状。所有患者均采用大疱开放插管引流术，该技术最初由莫纳尔迪设计用于治疗肺内结核性脓肿，现有所改良。3例患者术后死亡。死亡率与术前低FEV1（中位数350 ml）和较高的术前动脉二氧化碳分压（PaCO2）（中位数7.8 kPa）相关。其余17例患者中有16例报告症状改善，并在中位随访期1.6年内得以维持。这伴随着肺功能的客观改善，FEV1中位数提高22%，肺总量中位数降低11%，残气量中位数降低26%。1例患者术后症状未改变。所描述的技术提供了一种通过微创手术对大疱进行减压的简单方法。它还允许日后在局部麻醉下通过闭合插管治疗更多大疱。事实证明，除了肺功能最差的患者外，该方法适用于所有患者，现已成为我们的首选治疗方法。
