Licker M, de Perrot M, Schweizer A, Tschopp J M, Robert J, Höhn L, Rochat T, Spiliopoulos A
Division d'Anesthésiologie, Hôpital Universitaire de Genève.
Schweiz Med Wochenschr. 1998 Mar 14;128(11):409-15.
In recent years, lung transplantation (LT) and volume reduction surgery (LVRS) have been proposed for selected patients with end-stage pulmonary emphysema. Retrospectively, we analyzed the perioperative time course of 30 patients with emphysema who underwent either LVRS (n = 17) or LT (n = 13). In the LVRS group, patients were significantly older, presented less severe functional disability and all but one could be extubated at the end of surgery. In contrast, patients undergoing LT required postoperative mechanical ventilation (19 +/- 11 hrs) and had a prolonged hospital stay (37 [25-60] days vs 19 [11-42] days in LVRS patients) due to reperfusion lung edema, infection, hemorrhage and acute rejection. Six months postoperatively, forced expiratory volume in 1 second was improved and was significantly larger after LT compared with LVRS (+200% vs +63%). Our preliminary results suggest that, although LT produces greater functional improvement, LVRS is associated with lower surgical risk and is an alternative therapy in selected patients with severe emphysema.
近年来，肺移植（LT）和减容手术（LVRS）已被推荐用于特定的终末期肺气肿患者。我们回顾性分析了30例接受LVRS（n = 17）或LT（n = 13）的肺气肿患者的围手术期病程。在LVRS组中，患者年龄显著更大，功能残疾程度较轻，除1例患者外，所有患者在手术结束时均可拔管。相比之下，接受LT的患者术后需要机械通气（19±11小时），并且由于再灌注肺水肿、感染、出血和急性排斥反应，住院时间延长（LVRS患者为19[11 - 42]天，LT患者为37[25 - 60]天）。术后6个月，1秒用力呼气量有所改善，与LVRS相比，LT术后该指标显著更高（分别增加200%和63%）。我们的初步结果表明，虽然LT能带来更大的功能改善，但LVRS手术风险较低，是特定重度肺气肿患者的一种替代治疗方法。
