Yusen R D, Trulock E P, Pohl M S, Biggar D G
Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA.
Semin Thorac Cardiovasc Surg. 1996 Jan;8(1):99-109.
Between January 1993 and April 1995, 84 patients with emphysema underwent bilateral lung volume reduction surgery at Barnes Hospital, Fifty-three patients had completed 3 months; 37 patients, 6 months; and 19 patients, 1 year of follow-up. Significant improvement was observed in spirometric parameters, oxygenation, 6-minute walking distance, dyspnea indices, and quality-of-life scores. The average increases in FEV1 were 52%, 51%, and 61%, at 3,6, and 12 months, respectively, after surgery. The most common postoperative complication, prolonged ( > 7 days) chest tube drainage, was present in 63% of the cases, and the mean duration of hospitalization in the survivors was 15 days (range 5 to 49 days). This has been reduced to 11 days (median 7.5 days) for the subsequent 40 patients. Five postoperative deaths occurred, 2 in the first, 2 in the third, and 1 in the fifth postoperative month, respectively. The overall mortality in the 84 patients was 6%, and the actuarial survival at 1 year was 93%. Volume reduction surgery is a promising therapeutic option for patients with an appropriate pattern of emphysema. Improvement has been sustained for more than 1 year, and long-term follow-up is planned to ascertain the duration of the benefits.
1993年1月至1995年4月期间，84例肺气肿患者在巴恩斯医院接受了双侧肺减容手术。53例患者完成了3个月的随访；37例患者完成了6个月的随访；19例患者完成了1年的随访。观察到肺功能参数、氧合、6分钟步行距离、呼吸困难指数和生活质量评分有显著改善。术后3个月、6个月和12个月时，第一秒用力呼气容积（FEV1）的平均增加分别为52%、51%和61%。最常见的术后并发症是胸腔闭式引流时间延长（>7天），63%的病例出现该情况，幸存者的平均住院时间为15天（范围为5至49天）。随后的40例患者的住院时间已缩短至11天（中位数为7.5天）。术后发生了5例死亡，分别在术后第1个月有2例，第3个月有2例，第5个月有1例。84例患者的总死亡率为6%，1年的精算生存率为93%。肺减容手术对于具有合适肺气肿类型的患者是一种有前景的治疗选择。改善情况已持续超过1年，计划进行长期随访以确定获益的持续时间。
