重症慢性阻塞性肺疾病合并肺大疱的微创治疗

摘要

Objective To explore the feasibility, surgical methods and results of the video-assisted thoracoscopic pulmonary bullectomy and lung volume reduction surgery ( LVRS) for patients with severe chronic obstructive pulmonary disease ( COPD) complicated with bullae of lung. Methods Between June 2007 and April 2012,12 patients with severe COPD complicated with bullae of lung underwent video-assisted thoracoscopic pulmonary bullectomy and LVRS. The lung protections should be taken all through the preoperative, intraoperative and postoperative procedures. The pulmonary bulla and the edge of the lung tissue were cut by Endo-GIA with absorbability polyglycolic acid (APA) repair material ( NEOVEIL). Blood gas analysis and pulmonary function test were performed before and after the operation. Results There was no death, serious lung infection and persistent leak occurred. All the patients weaned from ventilator support in 2 days. The dyspnea symptoms improved with the MRC dyspnea scale dropped from grade Ⅳ to grade Ⅱ in 3 of the 12 cases, and to grade Ⅲ in the other 9 cases. The FEV1 , FEV1% and PaO2 increased but PaCO2 declined (P<0.01) in three months after the operations. Conclusions Patients with severe COPD complicated with bullae of lung, who have poor lung function, can tolerate video-assisted thoracoscopic pulmonary bullectomy or LVRS. The operations can improve their pulmonary functions.%目的 探讨重症慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并肺大疱行胸腔镜肺大疱切除术、肺减容术(lung volume reduction surgery,LVRS)的可行性. 方法 2007年6月～2012年4月,对12例重症COPD(合并Ⅱ型呼吸衰竭)的肺大疱行胸腔镜肺大疱切除、LVRS.术前、术中、术后充分做好肺保护,术中用垫有奈维材料的内镜切割缝合器(Endo-GIA)切除肺大疱和肺的边缘组织.比较患者手术前后血气分析及肺功能改善情况.结果 全组无死亡,未出现持续性漏气和严重肺部感染,术后2天内均脱离呼吸机.术后呼吸困难症状明显改善,英国医学研究委员会(medical research council,MRC)呼吸困难量表分级由Ⅳ级降为Ⅱ级3例,Ⅲ级9例.术后3个月复查肺功能第1秒用力呼气容积(FEV1)、FEV1占预计值百分比(FEV1％)及血气分析氧分压(PaO2)升高,二氧化碳分压(PaCO2)降低(P＜0.01). 结论 对于肺功能较差的重症COPD合并肺大疱患者可行胸腔镜肺大疱切除、肺减容术,手术治疗能有效改善肺功能.