肺减容手术改变了重度慢性阻塞性肺疾病患者肺结节的处理方式。

Ojo T C, Martinez F, Paine R, Christensen P J, Curtis J L, Weg J G, Kazerooni E A, Whyte R

Division of Pulmonary and Critical Care Medicine, University of Michigan Medical Center, Ann Arbor 48109-0326, USA.

Chest. 1997 Dec;112(6):1494-500. doi: 10.1378/chest.112.6.1494.

OBJECTIVE

To examine the role of lung volume reduction surgery (LVRS) in expanding the treatment options for patients with single pulmonary nodules and emphysema.

METHODS

Retrospective review of all patients undergoing LVRS at the University of Michigan between January 1995 and June 1996. Those undergoing simultaneous LVRS and resection of a suspected pulmonary malignancy formed the study group and underwent history and physical examination, pulmonary function tests, chest radiography, and high-resolution CT of the chest. If heterogeneous emphysema was found, cardiac imaging and single-photon emission CT perfusion lung scanning were performed. All study patients participated in pulmonary rehabilitation preoperatively. Age- and sex-matched patients who had undergone standard lobectomy for removal of pulmonary malignancy during the same period formed the control group.

RESULTS

Of 75 patients who underwent LVRS, 11 had simultaneous resection of a pulmonary nodule. In 10 patients, the nodules were radiographically apparent with 1 demonstrating central calcification. Histologic evaluation revealed six granulomas, two hamartomas, and three neoplastic lesions (one adenocarcinoma, one squamous cell, and one large cell carcinoma). Preoperative FEV1 was 26.18+/-2.49% predicted in the LVRS group and 81.36+/-6.07% predicted (p=0.000001) in the control group, and the FVC was 65.27+/-5.17% predicted vs 92.18+/-5.53% predicted (p=0.002). Two LVRS patients had a PaCO2 >45 mm Hg while 11 exhibited oxygen desaturation during a 6-min walk test. Postoperative complications occurred in two LVRS patients and three control patients. The mean length of stay in the LVRS group (7.55+/-1.10 days) was not different than in the control group (8.81+/-1.56 days). Three months after LVRS and simultaneous nodule resection, FEV1 rose by 47%, FVC by 25%, and all study patients noted less dyspnea as measured by transitional dyspnea index.

CONCLUSIONS

Simultaneous LVRS and resection of a suspected bronchogenic carcinoma is feasible and associated with minimal morbidity and significantly improved pulmonary function and dyspnea.

目的

探讨肺减容手术（LVRS）在扩大单发性肺结节合并肺气肿患者治疗选择方面的作用。

方法

回顾性分析1995年1月至1996年6月在密歇根大学接受LVRS的所有患者。同时接受LVRS及疑似肺恶性肿瘤切除术的患者组成研究组，接受病史及体格检查、肺功能测试、胸部X线摄影及胸部高分辨率CT检查。若发现存在异质性肺气肿，则进行心脏成像及单光子发射CT灌注肺扫描。所有研究患者术前均参加肺康复治疗。同期接受标准肺叶切除术以切除肺恶性肿瘤的年龄及性别匹配患者组成对照组。

结果

在75例行LVRS的患者中，11例同时切除了肺结节。10例患者的结节在影像学上明显可见，1例显示中央钙化。组织学评估显示6例为肉芽肿，2例为错构瘤，3例为肿瘤性病变（1例腺癌、1例鳞状细胞癌和1例大细胞癌）。LVRS组术前FEV1为预测值的26.18±2.49%，对照组为预测值的81.36±6.07%（p = 0.000001）；FVC分别为预测值的65.27±5.17%和92.18±5.53%（p = 0.002）。2例LVRS患者PaCO2>45 mmHg，11例在6分钟步行试验中出现氧饱和度下降。LVRS组2例患者及对照组3例患者发生术后并发症。LVRS组平均住院时间（7.55±1.10天）与对照组（8.81±1.56天）无差异。LVRS及同期结节切除术后3个月，FEV1上升47%，FVC上升25%，所有研究患者经过渡性呼吸困难指数测量显示呼吸困难减轻。