A randomized prospective trial of stapled lung reduction versus laser bullectomy for diffuse emphysema

详细信息    查看全文

• 作者：Robert J. McKenna Jr. ; Matthew Brenner ; Arthur F. Gelb ; Michael Mullin ; Narindar Singh ; Harold Peters ; John Panzera ; Jane Calmese ; Mark J. Schein
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：1996
• 出版时间：February 1996
• 年：1996
• 卷：111
• 期：2
• 页码：317-322
• 全文大小：640 K

文摘

Two procedures (laser bullectomy and lung reduction surgery with staples) are currently available for the surgical treatment of patients with diffuse emphysema. We compared the efficacy of these two surgical approaches in 72 patients, aged 67 ± 7 years (mean ± standard deviation), who had diffuse emphysema scored as severe on computed tomography and severe fixed expiratory airflow obstruction. The patients were prospectively randomized to undergo either neodymium:yttrium aluminum garnet contact laser surgery ( n = 33) or stapled lung reduction surgery ( n = 39) by unilateral thoracoscopy. The operative mortalities were 0 % and 2.5 % , respectively. No significant differences were noted between the groups ( p < 0.05) with respect to operating time, hospital days, or air leakage for more than 7 days. However, a delayed pneumothorax developed in six patients (18 % ) who had laser treatment ( p = 0.005). The operations eliminated dependency on supplemental oxygen in 52 % of the laser group and 87.5 % of the stapled lung reduction group ( p = 0.02). The mean postoperative improvement in the forced expiratory volume in 1 second at 6 months was significantly greater for the patients undergoing the staple technique (32.9 % vs 13.4 % , p = 0.01) than for the laser treatment group. (J THORAC CARDIOVASC SURG 1996;111:317-22)