Chung H J, Chiu A W, Chen K K, Huang W J, Hsu Y S, Chang L S
Department of Surgery, National Yang-Ming University, School of Medicine, Veterans General Hospital-Taipei, Taiwan, Republic of China.
Br J Urol. 1996 Dec;78(6):821-5. doi: 10.1046/j.1464-410x.1996.02572.x.
To evaluate and compare changes in pulmonary function after retroperitoneoscopic and open surgery.
From June 1994 to October 1995. 11 patients (five men and six women, mean age 44.7 years, range 29-69) underwent retroperitoneoscopic procedures (Group 1) and 11 patients (eight men and three women, mean age 57.5 years, range 22-73) underwent flank-incision procedures (Group 2). The surgery comprised eight adrenalectomies and one each of nephroureterectomy, nephrectomy and pyelolithotomy in Group 1, and five adrenalectomies, four nephroureterectomies, one ureterolithotomy and one excision of a retroperitoneal tumour in Group 2. Pulmonary function tests (PFTs) were performed before and 3 days after surgery; the forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), forced expiratory volume at 25% (FEV25%), FEV1/FVC, vital capacity (VC), total lung capacity (TLC), residual lung volume (RV) and functional residual capacity (FRC) were compared between the groups. The post-operative changes in the PFTs were assessed using a paired t-test and the degree of change in both groups compared using the Mann-Whitney U-test. Other factors possibly influencing PFT were analysed using multiple regression.
Pulmonary function was impaired in both groups on the third day after surgery. In Group 2, the FVC, FEV1, FEV25%, VC and TLC had declined significantly (all P < 0.05) from the pre-operative value. In Group 1, only the FVC and VC decreased significantly (P < 0.05). Post-operative pulmonary complications occurred in two patients in Group 2 but in none of those in Group 1, showing that pulmonary function was generally less affected in Group 1 than in Group 2.
Although pulmonary function was impaired 3 days after surgery in both groups, retroperitoneoscopic surgery, by eliminating a large flank incision, caused less post-operative pulmonary dysfunction than open surgery.
评估并比较后腹腔镜手术与开放手术后肺功能的变化。
1994年6月至1995年10月，11例患者（5例男性，6例女性，平均年龄44.7岁，范围29 - 69岁）接受了后腹腔镜手术（第1组），11例患者（8例男性，3例女性，平均年龄57.5岁，范围22 - 73岁）接受了经腰切口手术（第2组）。第1组手术包括8例肾上腺切除术、1例肾输尿管切除术、1例肾切除术和1例肾盂切开取石术；第2组手术包括5例肾上腺切除术、4例肾输尿管切除术、1例输尿管切开取石术和1例腹膜后肿瘤切除术。在手术前及术后3天进行肺功能测试（PFTs）；比较两组的用力肺活量（FVC）、第1秒用力呼气量（FEV1）、25%用力呼气量（FEV25%）、FEV1/FVC、肺活量（VC）、肺总量（TLC）、残气量（RV）和功能残气量（FRC）。使用配对t检验评估PFTs的术后变化，并使用Mann-Whitney U检验比较两组的变化程度。使用多元回归分析其他可能影响PFT的因素。
两组患者术后第3天肺功能均受损。在第2组中，FVC、FEV1、FEV25%、VC和TLC较术前值均显著下降（均P < 0.05）。在第1组中，仅FVC和VC显著下降（P < 0.05）。第2组有2例患者发生术后肺部并发症，而第1组无1例发生，表明第1组肺功能总体上比第2组受影响小。
虽然两组患者术后3天肺功能均受损，但后腹腔镜手术因避免了大的经腰切口，术后肺功能障碍比开放手术少。
