Kramer M R, Bar I, Eidelman I, Bublil M, Nitzan I, Sprung C, Godfrey S, Merin G
Dept. of Cardiothoracic Surgery, Hadassah-University Hospital, Jerusalem.
Harefuah. 1997 Jan 15;132(2):73-6, 152.
Volume reduction surgery (VRS) is a new procedure based on the concept that relieving hyperinflation in emphysema improves diaphragmatic and chest wall mechanics and ventilation perfusion mismatch. We present our early experience with 16 patients who underwent VRS from August 1995 to June 1996. Patient selection was based on: PFT, CT scan, V/Q scan, ABG's and 6-min walk. After pulmonary rehabilitation, operation was by median sternotomy and bilateral lung shaving. Pulmonary function improved significantly. FEV1 increased from 0.68 +/- 0.2 to 1.0 +/- 0.2 L (p < 0.01) and FVC increased from 1.7 +/- 0.5 to 2.7 +/- 0.5 L (p < 0.017). Total lung capacity decreased from 129% +/- 24% to 108% +/- 20% (p < 0.03). 6-min walk increased from 221 +/- 90 to 404 +/- 123 meters (p < 0.001). Complications included 1 death, prolonged air leak in 7 cases and infection in 2. Quality of life improved substantially in 12 of the 16 cases; in 3 cases there was only slight improvement and in 1 the condition became worse. Volume reduction surgery is a promising surgical solution in selected patients with advanced emphysema.
肺减容手术（VRS）是一种基于缓解肺气肿过度充气可改善膈肌和胸壁力学以及通气灌注不匹配这一概念的新手术。我们介绍了1995年8月至1996年6月期间接受VRS的16例患者的早期经验。患者选择基于：肺功能测试（PFT）、计算机断层扫描（CT）、通气/灌注扫描（V/Q）、动脉血气分析（ABG）和6分钟步行试验。经过肺康复后，通过正中胸骨切开术和双侧肺削切术进行手术。肺功能显著改善。第一秒用力呼气容积（FEV1）从0.68±0.2升增加到1.0±0.2升（p<0.01），用力肺活量（FVC）从1.7±0.5升增加到2.7±0.5升（p<0.017）。肺总量从129%±24%降至108%±20%（p<0.03）。6分钟步行距离从221±90米增加到404±123米（p<0.001）。并发症包括1例死亡、7例持续漏气和2例感染。16例中有12例生活质量显著改善；3例仅有轻微改善，1例病情恶化。肺减容手术对于选定的晚期肺气肿患者是一种有前景的手术解决方案。
