Travaline J M, Furukawa S, Kuzma A M, O'Brien G M, Criner G J
Division of Pulmonary and Critical Care Medicine, and Cardiothoracic Surgery, Temple University School of Medicine, Philadelphia, PA 19140, USA.
Chest. 1998 Oct;114(4):981-7. doi: 10.1378/chest.114.4.981.
To determine whether biapical stapling resection alone or resection of diseased, nonapical areas of emphysematous lung provides comparable physiologic outcomes or alters morbidity and mortality after lung volume reduction surgery (LVRS).
Consecutive case-series analysis.
Urban university hospital.
Forty-seven patients ([mean +/- SD] aged 58+/-8 years; 18 men) with severe emphysema (FEV1, 0.7+/-0.2 L; total lung capacity [TLC], 139+/-23% predicted).
Thirty-two patients underwent biapical LVRS, 27 by median sternotomy (MS) and 5 by video-assisted thoracoscopic surgery (VATS), and 15 underwent nonapical resection, 9 by MS and 6 by VATS. Patients were assessed for postoperative complications (respiratory tract infections, air leak duration, and death), length of stay, and physiologic parameters, which included a 6-min walk distance, spirometry, lung volume, gas exchange, diaphragm strength, and quality-of-life measures.
Patients were studied at baseline and at 3 months postoperatively. At the preoperative baseline, both groups had similar ages (57 vs 60 years; p = 0.2), 6-min walk distance (294 vs 263 m; p = 0.3), FEV1 (28% vs 29% predicted; p = 0.6), degree of hyperinflation (TLC, 138% vs 141% predicted; p = 0.8), gas exchange (PaO2/fraction of inspired oxygen, 344 vs 313, p = 0.1; PaCO2 46 vs 48 mm Hg, p = 0.4), and diaphragm strength (maximal transdiaphragmatic pressure sniff, 54 vs 46 cm H2O, p = 0.4). Resected tissue weight was similar in both groups (94 vs 93 g, p = 0.9). There were no differences in the mean percentage of change from baseline for these physiologic parameters or for quality-of-life measures between the two groups. The 6-min walk distances increased by 20% and 33%, FEV1 increased by 37% and 38%, the degrees of hyperinflation (residual volume/TLC) decreased by 16% and 15%, and the quality-of-life scores improved by 51% and 41%, respectively, in the groups that underwent biapical and nonapical resections at 3 months post-LVRS. The length of stay in the hospital for LVRS (18 vs 23 days; p = 0.4) and the duration of air leak (10 vs 15 days; p = 0.4) were also similar. Complications between the two groups (biapical vs nonapical) were similar (respiratory tract infection, 47% vs 60%, p = 0.2; reintubation, 34% vs 33%, p = 0.2; reoperation, 9% vs 20%, p = 0.4; and death, 9% vs 7%, p = 0.2).
LVRS, by biapical or nonapical resection, produces similar improvements in lung function, exercise, diaphragm strength, and quality of life, with comparable morbidity and mortality.
确定单纯双尖部吻合器切除术或切除肺气肿肺的病变非尖部区域，在肺减容手术（LVRS）后是否能提供相似的生理结果，或改变发病率和死亡率。
连续病例系列分析。
城市大学医院。
47例重度肺气肿患者（[平均±标准差]年龄58±8岁；18例男性）（第1秒用力呼气容积[FEV1]为0.7±0.2L；肺总量[TLC]为预测值的139±23%）。
32例患者接受双尖部LVRS，其中27例通过正中胸骨切开术（MS），5例通过电视辅助胸腔镜手术（VATS）；15例接受非尖部切除术，其中9例通过MS，6例通过VATS。评估患者的术后并发症（呼吸道感染、漏气持续时间和死亡）、住院时间和生理参数，生理参数包括6分钟步行距离、肺量测定、肺容积、气体交换、膈肌力量和生活质量指标。
在基线和术后3个月对患者进行研究。在术前基线时，两组患者年龄相似（57岁对60岁；p=0.2），6分钟步行距离相似（294米对263米；p=0.3），FEV1相似（预测值的28%对29%；p=0.6），肺过度充气程度相似（TLC为预测值的138%对141%；p=0.8），气体交换相似（动脉血氧分压/吸入氧分数为344对313，p=0.1；动脉血二氧化碳分压为46对48mmHg，p=0.4），膈肌力量相似（最大跨膈压吸气时为54对46cmH₂O，p=0.4）。两组切除组织重量相似（94克对93克，p=0.9）。两组间这些生理参数或生活质量指标从基线开始的平均变化百分比无差异。在LVRS术后3个月，接受双尖部和非尖部切除术的两组患者中，6分钟步行距离分别增加了20%和33%，FEV1分别增加了37%和38%，肺过度充气程度（残气量/TLC）分别降低了16%和15%，生活质量评分分别提高了51%和41%。LVRS的住院时间（18天对23天；p=0.4）和漏气持续时间（10天对15天；p=0.4）也相似。两组间（双尖部对非尖部）并发症相似（呼吸道感染，47%对60%，p=0.2；再次插管，34%对33%，p=0.2；再次手术，9%对20%，p=0.4；死亡，9%对7%，p=0.2）。
通过双尖部或非尖部切除术进行LVRS，在肺功能、运动能力、膈肌力量和生活质量方面产生相似的改善，发病率和死亡率相当。
