Date H, Goto K, Souda R, Nagashima H, Togami I, Endou S, Aoe M, Yamashita M, Andou A, Shimizu N
Department of Surgery II, Okayama University School of Medicine, Japan.
Ann Thorac Surg. 1998 Apr;65(4):939-42. doi: 10.1016/s0003-4975(98)00115-5.
Lung volume reduction surgery either via sternotomy or by thoracoscopy has been demonstrated to be effective for selected emphysema patients in North America and Europe. The present study summarizes short-term results of bilateral lung volume reduction performed via median sternotomy for the first consecutive 39 patients with severe diffuse emphysema in Okayama, Japan, from July 1995 to February 1997.
There were 35 men and 4 women, and the age range was 54 to 74 years with a mean age of 65 years. All were former heavy smokers and none of them had alpha1-antitrypsin deficiency. Only 9 patients (23%) showed a bilateral upper lobe pattern of emphysema. The operation was done through a median sternotomy, and the most emphysematous portions were excised bilaterally with a linear stapling device fitted with strips of bovine pericardium to prevent air leakage.
No operative death was encountered. The first 33 patients completed 3-month follow-up assessment, and their mean forced expiratory volume in 1 second had improved by 41% from 735 mL to 1,037 mL. Other parameters of pulmonary function tests, arterial blood gas analysis, 6-minute walking distance, and dyspnea scale also had improved significantly. These improvements lasted for at least a year.
Bilateral lung volume reduction surgery via median sternotomy is a safe and effective procedure for selected severe emphysema patients. Although the pattern of emphysema might be different between countries, the results in Japanese patients were similar to those previously reported in North American and European patients.
在北美和欧洲，经胸骨切开术或胸腔镜进行的肺减容手术已被证明对部分肺气肿患者有效。本研究总结了1995年7月至1997年2月在日本冈山，对首批连续39例重度弥漫性肺气肿患者经正中胸骨切开术进行双侧肺减容的短期结果。
患者中男性35例，女性4例，年龄范围为54至74岁，平均年龄65岁。所有患者均为既往重度吸烟者，且均无α1-抗胰蛋白酶缺乏症。仅9例患者（23%）表现为双侧上叶型肺气肿。手术通过正中胸骨切开术进行，使用装有牛心包条带的线性缝合器双侧切除最严重的肺气肿部分，以防止漏气。
未发生手术死亡。前33例患者完成了3个月的随访评估，其1秒用力呼气量平均从735毫升提高到1037毫升，提高了41%。肺功能测试、动脉血气分析、6分钟步行距离和呼吸困难量表的其他参数也有显著改善。这些改善至少持续了一年。
经正中胸骨切开术进行双侧肺减容手术对部分重度肺气肿患者是一种安全有效的手术方法。尽管不同国家肺气肿的类型可能不同，但日本患者的结果与北美和欧洲患者先前报道的结果相似。
