Clinic for Thoracic Surgery, University Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia.
Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
Eur J Med Res. 2024 May 10;29(1):279. doi: 10.1186/s40001-024-01879-4.
While pharmacologic therapy remains the cornerstone of lung emphysema treatment, surgery is an additional therapeutic option in selected patient groups with advanced emphysema. The aim of lung volume reduction surgery (LVRS) is to improve lung function, exercise capacity, quality of life and survival. We sought to determine the therapeutic value of surgical resection in specific patients with lung emphysema.
A retrospective study was performed consisting of 58 patients with lung emphysema who underwent surgical intervention over a 10-year period and were followed for 2 years postoperatively. The clinical characteristics recorded were FEV (forced expiratory volume in 1 s), the 6-min walk test (6-MWT), the Modified Medical Research Council (mMRC), body mass index (BMI) and quality of life prior to and 6, 12 and 24 months after surgical intervention. Moreover, all peri- and post-operative complications were noted.
Out of 58 emphysema patients (72% male, FEV (L) 2.21 ± 0.17, RV (L) 3.39 ± 0.55), 19 underwent surgical bullectomy, 31 unilateral LVRS and 8 sequential bilateral LVRS. Six months after surgery, there was a statistically significant improvement in FEV, RV, TLC, 6-MWT and mMRC. Over a period of 12 to 24 months postoperatively, clinical benefit gradually declines most likely due to COPD progression but patients still experienced a significant improvement in FEV. The most common postoperative complications were persistent air leakage (> 7 days), arrhythmia and subcutaneous emphysema in 60%, 51.6% and 22.4%, respectively. No deaths were observed after surgical intervention.
In a selected patient population, surgery led to significant improvement of lung function parameters, exercise capacity and quality of life. Over a period of 12 to 24 months postoperatively, clinical benefit gradually decreased most likely due to COPD progression.
虽然药物治疗仍然是肺气肿治疗的基石，但对于晚期肺气肿的特定患者群体，手术是另一种治疗选择。肺减容手术（LVRS）的目的是改善肺功能、运动能力、生活质量和生存率。我们旨在确定手术切除在特定肺气肿患者中的治疗价值。
进行了一项回顾性研究，共纳入 58 例在 10 年内接受手术干预的肺气肿患者，并在术后 2 年内进行随访。记录的临床特征包括用力呼气量（FEV）、6 分钟步行试验（6-MWT）、改良医学研究委员会呼吸困难量表（mMRC）、体重指数（BMI）和手术干预前以及术后 6、12 和 24 个月的生活质量。此外，还记录了所有围手术期和术后并发症。
58 例肺气肿患者中（72%为男性，FEV（L）2.21±0.17，RV（L）3.39±0.55），19 例行手术肺大疱切除术，31 例行单侧 LVRS，8 例行序贯双侧 LVRS。手术后 6 个月，FEV、RV、TLC、6-MWT 和 mMRC 均有统计学显著改善。在术后 12 至 24 个月期间，临床获益逐渐下降，可能是由于 COPD 进展，但患者的 FEV 仍有显著改善。最常见的术后并发症是持续漏气（>7 天）、心律失常和皮下气肿，发生率分别为 60%、51.6%和 22.4%。手术干预后无死亡病例。
在选定的患者群体中，手术导致肺功能参数、运动能力和生活质量显著改善。在术后 12 至 24 个月期间，临床获益逐渐下降，可能是由于 COPD 进展。
