Okumus Özlem, Seebacher Gernot, Valdivia Daniel, Slama Alexis, Darwiche Kaid, Karpf-Wissel Rüdiger, Wienker Johannes, Collaud Stephane, Kampe Sandra, Hegedüs Balazs, Aigner Clemens
Department of Thoracic Surgery, University Medicine Essen-Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany.
Department of Thoracic Surgery, Cologne-Merheim Hospital, Witten/Herdecke University, Cologne, Germany.
Interdiscip Cardiovasc Thorac Surg. 2024 Oct 8;39(4). doi: 10.1093/icvts/ivae169.
Lung volume reduction surgery (LVRS) is an established treatment approach for patients with severe pulmonary emphysema, enhancing lung function and quality of life in selected patients. Functional benefits and outcomes after uni- versus bilateral lung volume reduction remain a topic of debate.
A retrospective analysis of patients undergoing LVRS from January 2018 to October 2022 was conducted. After encouraging initial results, the standard unilateral LVRS approach was switched to bilateral. The goal of this study was to assess the impact on functional outcomes at 3 and 6 months post-surgery compared to preoperative levels for the uni- versus the bilateral approach.
A total of 83 patients were included (43 bilateral, 40 unilateral). Baseline demographic and functional parameters were comparable between groups. The most common complication was prolonged air leak in 19 patients (11 in the unilateral group, 8 in the bilateral group). Two patients died perioperatively (2.4%). Overall, LVRS improved forced expiratory volume in 1 s by 8.3% after 3 and 12.5% after 6 months postoperatively compared to baseline. Bilateral surgery presented significantly superior forced expiratory volume in 1 s improvement than unilateral approach at both 3 (29.2% versus 2.9%; P = 0.0010) and 6 months (21.5% versus 3%; P = 0.0310) postoperatively. Additionally, it reduced hyperinflation (residual volume) by 23.1% after 3 months and by 17.5% after 6 months, compared to reductions of 16% and 9.1% in the unilateral group.
Bilateral approach resulted in better functional outcomes 3 and 6 months postoperatively compared to unilateral surgery.
肺减容手术（LVRS）是重度肺气肿患者的一种既定治疗方法，可改善部分患者的肺功能和生活质量。单侧与双侧肺减容术后的功能益处和结果仍是一个有争议的话题。
对2018年1月至2022年10月接受LVRS的患者进行回顾性分析。在取得令人鼓舞的初步结果后，标准的单侧LVRS方法改为双侧。本研究的目的是评估与术前水平相比，单侧与双侧手术方法在术后3个月和6个月时对功能结果的影响。
共纳入83例患者（43例双侧，40例单侧）。两组间的基线人口统计学和功能参数具有可比性。最常见的并发症是19例患者出现持续性漏气（单侧组11例，双侧组8例）。2例患者围手术期死亡（2.4%）。总体而言，与基线相比，LVRS术后3个月1秒用力呼气量改善了8.3%，术后6个月改善了12.5%。双侧手术在术后3个月（29.2%对2.9%；P = 0.0010）和6个月（21.5%对3%；P = 0.0310）时，1秒用力呼气量的改善明显优于单侧手术。此外，与单侧组分别降低16%和9.1%相比，双侧手术在术后3个月时将肺过度充气（残气量）降低了23.1%，术后6个月时降低了17.5%。
与单侧手术相比，双侧手术方法在术后3个月和6个月时产生了更好的功能结果。
