Mineo T C, Pompeo E, Simonetti G, Sabato A F, Turani F, Rogliani P, De Padova F, Nofroni I
Department of Thoracic Surgery, Tor Vergata University, Rome, Italy.
Eur J Cardiothorac Surg. 1998 Jul;14(1):33-9. doi: 10.1016/s1010-7940(98)00134-1.
We prospectively analyzed the surgical and functional results of unilateral thoracoscopic reduction pneumoplasty which we performed by choice in patients with asymmetric emphysema.
Between October 1995 and June 1997, 119 emphysematous patients were examined and 34 were operated upon. Among these, 14 selected patients with asymmetric distribution of emphysema in the lungs underwent unilateral reduction pneumoplasty (ten right, and four left). There were 13 males and one female, with a mean age of 62 years. Eligibility criteria included bullous and non-bullous end-stage emphysema with severe limitation to daily activity.
No patient required conversion to thoracotomy. Mean operative time ranged between 70 and 240 min with a mean of 103 min. There was no postoperative mortality but five patients developed one or more complications: five prolonged air leaks (>7 days); two pulmonary infections; one empyema. No patient required postoperative mechanical ventilation. Median hospital stay was 8 days. At the 3-month follow-up the mean FEV1 increased from 0.8 l to 1.2 l (P < 0.001). Mean FVC increased from 2.6 l to 2.9 l (P < 0.001). The Medical Research Council dyspnea score decreased from a mean of 3.2 to 1.8 (P < 0.001).
Asymmetric distribution is a frequent finding in patients with severe emphysema. Unilateral thoracoscopic reduction pneumoplasty may represent an ideal approach in this selected group of patients.
我们前瞻性地分析了选择性对非对称性肺气肿患者实施的单侧胸腔镜减容肺成形术的手术及功能结果。
1995年10月至1997年6月期间，对119例肺气肿患者进行了检查，其中34例接受了手术。在这些患者中，14例肺部肺气肿呈非对称分布的患者接受了单侧减容肺成形术（右侧10例，左侧4例）。患者中有13名男性和1名女性，平均年龄62岁。入选标准包括大疱性和非大疱性终末期肺气肿，日常活动严重受限。
无患者需要转为开胸手术。平均手术时间为70至240分钟，平均103分钟。无术后死亡病例，但有5例患者出现了一种或多种并发症：5例持续性漏气（>7天）；2例肺部感染；1例脓胸。无患者需要术后机械通气。中位住院时间为8天。在3个月的随访中，平均第一秒用力呼气容积（FEV1）从0.8升增加到1.2升（P<0.001）。平均用力肺活量（FVC）从2.6升增加到2.9升（P<0.001）。医学研究委员会呼吸困难评分从平均3.2降至1.8（P<0.001）。
非对称分布在重度肺气肿患者中很常见。单侧胸腔镜减容肺成形术可能是这类特定患者群体的理想治疗方法。
