Cooper J D, Patterson G A, Sundaresan R S, Trulock E P, Yusen R D, Pohl M S, Lefrak S S
Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Mo 63110, USA.
J Thorac Cardiovasc Surg. 1996 Nov;112(5):1319-29; discussion 1329-30. doi: 10.1016/S0022-5223(96)70147-2.
Between January 1993 and February 1996, we performed 150 bilateral lung volume reduction procedures for patients with severe emphysema. Patients were selected on the basis of severe dyspnea, increased lung capacity, and a pattern of emphysema that included regions of severe destruction, hyperinflation, and poor perfusion. Twenty percent to 30% of the volume of each lung was excised with the use of a linear stapler and bovine pericardial strips attached to buttress the staple line. Patients were between 36 and 77 years old, with an average 1-second forced expiratory volume of 25% of predicted, total lung capacity of 142% of predicted, and residual volume of 283% of predicted. Ninety-three percent of patients required supplemental oxygen, continuously or with exertion. All patients but one were extubated at the end of the procedure. The 90-day mortality was 4%. Hospital stay progressively decreased with experience, and for the last 50 patients the median hospital stay was 7 days. Prolonged air leakage was the major complication. Results at 6 months show a 51% increase in the 1-second forced expiratory volume and a 28% reduction in the residual volume. The Pao2 increased by an average of 8 mm Hg, and 70% of the patients who had previously required continuous supplemental oxygen no longer had this requirement. The improvements in measured pulmonary function were paralleled by a significant reduction in dyspnea and an improvement in the quality of life. Reevaluation at 1 year and 2 years after operation showed the benefit to be well maintained. We conclude that lung volume reduction offers benefits not achievable by any means other than lung transplantation for highly selected patients with severe emphysema.
1993年1月至1996年2月期间，我们为重度肺气肿患者实施了150例双侧肺减容手术。入选患者的依据是严重呼吸困难、肺容量增加以及肺气肿的表现，包括严重破坏区域、肺过度充气和灌注不良。使用线性缝合器并附加牛心包条带以加固缝合线，切除每侧肺20%至30%的体积。患者年龄在36至77岁之间，平均1秒用力呼气量为预测值的25%，肺总量为预测值的142%，残气量为预测值的283%。93%的患者需要持续或运动时吸氧。除1例患者外，所有患者在手术结束时均拔除气管插管。90天死亡率为4%。住院时间随着经验的积累逐渐缩短，最后50例患者的中位住院时间为7天。长时间漏气是主要并发症。6个月时的结果显示，1秒用力呼气量增加51%，残气量减少28%。动脉血氧分压平均升高8毫米汞柱，70%之前需要持续吸氧的患者不再有此需求。肺功能测量的改善与呼吸困难的显著减轻和生活质量的提高相平行。术后1年和2年的重新评估显示，益处得到良好维持。我们得出结论，对于高度选择的重度肺气肿患者，肺减容术提供了除肺移植以外其他方法无法实现的益处。
