Castillo-Larios Rocio, Yu Lee-Mateus Alejandra, Hernandez-Rojas Daniel, Pulipaka Priyanka, Thomas Mathew, Jacob Samuel, El-Sayed Ahmed Magdy M, Fernandez-Bussy Sebastian, Abia-Trujillo David, Makey Ian A
Department of General Surgery, Mayo Clinic Florida, Jacksonville, FL, USA.
Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic Florida, Jacksonville, FL, USA.
J Thorac Dis. 2024 Oct 31;16(10):6406-6416. doi: 10.21037/jtd-23-1655. Epub 2024 Oct 30.
Lung volume reduction surgery (LVRS) has historically been performed as a bilateral operation. We aimed to compare the short-term morbidity and mortality between unilateral and bilateral LVRS.
We performed a retrospective analysis of patients who underwent LVRS for emphysema at two hospital sites over 10 years. Outcomes were compared between unilateral and bilateral LVRS by final approach. Functional outcomes included pulmonary functions tests (PFTs), 6-minute walk test (6MWT), and supplemental oxygen use.
A total of 119 patients underwent LVRS. A unilateral approach was used in 64 (54%) patients, and the bilateral approach in 55 (46%). For the entire cohort, functional outcomes significantly improved post-LVRS. Bilateral LVRS showed non-significant improvement in residual volume (RV%) (-77.5 -45, P=0.07) and forced expiratory volume in the first second (FEV%) (+6.3% +13%, P=0.07), and statistically significant improvement in diffusing capacity for carbon monoxide (DLCO%) (+2% +9%, P=0.01), and 6MWT (-4 +42.8, P=0.007) compared to the unilateral group. Procedure-related air leak (5 2.5, P=0.03) and chest tube days (7 4, P=0.01), and a longer hospital stay (8 5, P<0.001) were longer in the bilateral group compared to the unilateral group. Estimated survival at 1-year was 98.4% for unilateral and 90.9% for bilateral LVRS (P=0.09).
Compared to unilateral LVRS, bilateral LVRS is associated with a greater functional improvement at the expense of short-term morbidity.
肺减容手术（LVRS）历来都是双侧手术。我们旨在比较单侧和双侧LVRS的短期发病率和死亡率。
我们对10年间在两个医院接受LVRS治疗肺气肿的患者进行了回顾性分析。根据最终手术方式比较单侧和双侧LVRS的结果。功能结局包括肺功能测试（PFTs）、6分钟步行试验（6MWT）和补充氧气使用情况。
共有119例患者接受了LVRS。64例（54%）患者采用单侧手术方式，55例（46%）采用双侧手术方式。对于整个队列，LVRS后功能结局有显著改善。与单侧组相比，双侧LVRS在残气量（RV%）（-77.5 -45，P=0.07）和第一秒用力呼气量（FEV%）（+6.3% +13%，P=0.07）方面改善不显著，但在一氧化碳弥散量（DLCO%）（+2% +9%，P=0.01）和6MWT（-4 +42.8，P=0.007）方面有统计学显著改善。与单侧组相比，双侧组的手术相关漏气（5 2.5，P=0.03）、胸管留置天数（7 4，P=0.01）更长，住院时间也更长（8 5，P<0.001）。单侧LVRS的1年估计生存率为98.4%，双侧LVRS为90.9%（P=0.09）。
与单侧LVRS相比，双侧LVRS虽功能改善更大，但以短期发病率增加为代价。
