Xu Xinnan, Dai Jie, Jin Kaiqi, Liu Xiaogang, Yang Yang, Ge Tao, Li Qiuyuan, Jiang Chao, He Wenxin, Wang Haifeng, Zhang Peng, Jiang Gening
Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China.
Interdiscip Cardiovasc Thorac Surg. 2024 Feb 2;38(2). doi: 10.1093/icvts/ivad175.
To provide the experience of surgical treatment for bronchiectasis-destroyed lung (BDL) and evaluate the feasibility of video-assisted thoracoscopic surgery (VATS).
BDL patients underwent surgical treatment between January 2013 and June 2018 were included. Logistic regression was performed to assess factors for major complications, and Cox's regression was performed to assess factors affected symptomatic outcome.
Totally, 143 patients were treated by VATS (n = 64) and thoracotomy (n = 79). Nine (14.1%) cases scheduled for VATS were converted to thoracotomy for dense adhesions (n = 6) and frozen hilum (n = 3). The VATS group had a median chest tube duration, hospitalization and a time of returning to full activity of 4 days, 5 days and 1.5 months, respectively. Major complications occurred in 28 (19.6%) of all patients, 50.0% after pneumonectomy and 13.4% after lobectomy/extensive lobectomy. Multivariable analysis identified pneumonectomy [odds ratio, 3.64; 95% confidence interval (CI), 1.18-11.21] as a significant predictor for major complications. Overall, 141 (98.6%) patients benefitted from surgery (completely asymptomatic, n = 109; acceptable alleviation, n = 32). Thirty-four patients experienced relapse of the disease, including 13 with productive cough, 11 with haemoptysis and 10 with recurrent infections. Pseudomonas aeruginosa infection [hazard ratio (HR), 3.07; 95% CI, 1.38-6.83] and extent of remanent bronchiectatic areas (HR, 1.03; 95% CI, 1.00-1.05) were independent risk factors for shorter relapse free interval.
VATS for BDL is feasible in well-selected patients. Pneumonectomy increased the risk of postoperative major complications. Removing all BDL lesions contributed to satisfactory prognosis.
提供支气管扩张毁损肺（BDL）的外科治疗经验并评估电视辅助胸腔镜手术（VATS）的可行性。
纳入2013年1月至2018年6月期间接受手术治疗的BDL患者。进行逻辑回归分析以评估主要并发症的相关因素，并进行Cox回归分析以评估影响症状转归的因素。
共有143例患者接受了VATS（n = 64）和开胸手术（n = 79）治疗。计划行VATS的患者中有9例（14.1%）因致密粘连（n = 6）和肺门冻结（n = 3）而转为开胸手术。VATS组胸腔引流管留置时间、住院时间和恢复完全活动时间的中位数分别为4天、5天和1.5个月。所有患者中有28例（19.6%）发生主要并发症，肺切除术后为50.0%，肺叶切除/扩大肺叶切除术后为13.4%。多变量分析确定肺切除术[比值比，3.64；95%置信区间（CI），1.18 - 11.21]是主要并发症的重要预测因素。总体而言，141例（98.6%）患者从手术中获益（完全无症状，n = 109；症状得到可接受缓解，n = 32）。34例患者疾病复发，包括13例有咳痰、11例有咯血和10例有反复感染。铜绿假单胞菌感染[风险比（HR），3.07；95% CI，1.38 - 6.83]和残留支气管扩张区域范围（HR，1.03；95% CI，1.00 - 1.05）是无复发生存期较短的独立危险因素。
对于精心挑选的患者，VATS治疗BDL是可行的。肺切除术增加了术后主要并发症的风险。切除所有BDL病变有助于获得满意的预后。
