Keller C A, Naunheim K S, Osterloh J, Espiritu J, McDonald J W, Ramos R R
Department of Internal Medicine, St. Louis University Health Sciences Center, MO 63110-0250, USA.
Chest. 1997 Apr;111(4):941-7. doi: 10.1378/chest.111.4.941.
This study reports histopathologic findings in a group of emphysema patients who underwent thoracoscopic lung volume reduction surgery (75) or sternotomy (five) with the purpose to induce functional improvement and relief of dyspnea. Immediate outcome and complications were correlated to histologic patterns.
Histopathologic material obtained in lung volume reduction surgery in 80 consecutive patients was analyzed. Thirty patients who had other histopathologic diagnoses in addition to emphysema were grouped and compared with 50 patients found to have emphysema exclusively. Postoperative outcome and preoperative lung function variables were compared.
All patients had severe obstructive lung disease and significant air trapping preoperatively documented by pulmonary function testing. All had severe exertional dyspnea. All had chest radiographs, CT, and nuclear medicine lung scans consistent only with emphysema. All portions of resected lung tissue were weighed, lung volume was estimated, and routine histopathologic studies were made. Thirty patients (37.5%) had unsuspected findings such as interstitial fibrosis, noncaseating granulomatosis, chronic inflammation, and unsuspected neoplasia (three carcinomas, one carcinoid). Retrospective review of imaging studies in these patients failed to show infiltrative processes. The average lung weight resected in this group was significantly heavier (65+/-18 g) compared with the other group (56+/-13 g), although both had the same estimated lung volume. Average number of days requiring chest tubes and length of hospitalization was also significantly higher (12.8+/-19 vs 6.4+/-5 days with chest tubes and 17.4+/-22 vs 8.5+/-6 days of hospitalization, respectively). None of the preoperative pulmonary function tests variables were different between the two groups. Serious postoperative complications were more frequent in these patients compared with those who showed only emphysema.
A significant portion of patients diagnosed as having severe emphysema will have other unsuspected histologic findings. When subjected to lung volume reduction surgery, this subgroup will have more serious complications and longer periods of air leaks, requiring longer hospitalization time. Retrospective review of imaging studies and preoperative pulmonary function tests used to select patients for lung volume reduction failed to identify this subgroup.
本研究报告了一组接受胸腔镜肺减容手术（75例）或胸骨切开术（5例）以改善功能和缓解呼吸困难的肺气肿患者的组织病理学发现。即时结果和并发症与组织学模式相关。
分析了连续80例接受肺减容手术获得的组织病理学材料。将30例除肺气肿外还有其他组织病理学诊断的患者分组，并与50例仅患有肺气肿的患者进行比较。比较了术后结果和术前肺功能变量。
所有患者术前均有严重的阻塞性肺疾病，肺功能测试记录有明显的气体潴留。所有患者均有严重的劳力性呼吸困难。所有患者的胸部X光片、CT和核医学肺部扫描结果仅与肺气肿相符。对切除的肺组织各部分进行称重，估计肺体积，并进行常规组织病理学研究。30例患者（37.5%）有意外发现，如间质纤维化、非干酪性肉芽肿病、慢性炎症和意外肿瘤（3例癌、1例类癌）。对这些患者的影像学研究进行回顾性分析未能显示浸润性病变。该组切除的肺平均重量（65±18克）明显重于另一组（56±13克），尽管两组的估计肺体积相同。需要胸管的平均天数和住院时间也明显更长（分别为12.8±19天与6.4±5天使用胸管，17.4±22天与8.5±6天住院）。两组术前肺功能测试变量无差异。与仅表现为肺气肿的患者相比，这些患者术后严重并发症更常见。
相当一部分被诊断为严重肺气肿的患者会有其他意外的组织学发现。接受肺减容手术时，该亚组会有更严重的并发症和更长时间的漏气，需要更长的住院时间。用于选择肺减容手术患者的影像学研究回顾性分析和术前肺功能测试未能识别出该亚组。
