Watanabe Y, Iwa T, Yashiki H, Kimoto H, Kobayashi H, Sato H, Yokoi K
Nihon Geka Gakkai Zasshi. 1984 Sep;85(9):929-33.
Eighteen patients with bilateral bullae underwent simultaneous operations via median sternotomy. Each patient had giant bullae occupying at least one third of the each hemithorax and also had various degree of exertional dyspnea. All patients showed subjective as well as objective improvement and there was no mortality or morbidity. Late follow-up study for objective evaluation of this operative procedure clarified that the forced expiratory volume for one second (FEV1.0) and arterial oxygen tension (PaO2) were significantly improved after the operation, whereas the vital capacity and arterial carbon dioxide tension (PaCO2) showed no apparent changes. Serial study of cardiopulmonary hemodynamics during the bilateral thoracotomy was performed with Swan-Ganz catheter and hemodilution method. By abrupt decompression of the cyst, decreases in pulmonary arterial pressure, cardiac output, or systemic arterial pressure were noted during the bilateral thoracotomy. These hemodynamic changes were much more evident in the cases ventilated by single lumen tube than the cases operated upon using double lumen tube with separate ventilation. This operative procedure was applied on the cases with bilateral spontaneous pneumothorax and metastatic lung tumor. The clinical advantages of this bilateral operation via median sternotomy were discussed.
18例双侧肺大疱患者经正中胸骨切开术同时进行手术。每位患者的巨大肺大疱至少占据每个半侧胸廓的三分之一，并且都有不同程度的劳力性呼吸困难。所有患者均有主观及客观改善，无死亡或并发症发生。为客观评估该手术方法而进行的后期随访研究表明，术后一秒用力呼气量（FEV1.0）和动脉血氧分压（PaO2）显著改善，而肺活量和动脉血二氧化碳分压（PaCO2）无明显变化。采用Swan-Ganz导管和血液稀释法对双侧开胸手术期间的心肺血流动力学进行了系列研究。在双侧开胸手术期间，通过囊肿突然减压，发现肺动脉压、心输出量或体动脉压下降。与使用双腔管单独通气进行手术的病例相比，单腔管通气的病例这些血流动力学变化更为明显。该手术方法应用于双侧自发性气胸和转移性肺肿瘤病例。讨论了经正中胸骨切开术进行双侧手术的临床优势。
