肺减容术治疗晚期肺气肿的临床经验
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摘要
目的:总结肺减容术治疗晚期肺气肿的临床经验。
研究方法:回顾性分析2009年5月到2010年12月我院22例肺减容术患者的临床资料。22例患者均行双腔气管插管,全身麻醉,均为单侧手术,其中胸腔镜或辅助小切口肺减容术17例,标准后外侧切口肺减容术5例。均采用直线切割闭合器切除过度膨胀而破坏的肺组织,并予生物蛋白胶封堵针眼。
结果:患者术后无自发性气胸复发,无手术死亡。呼吸困难症状明显减轻,术后三月检测血气分析较术前动脉血氧分压平均上升17mmHg,FEV1增加57%,RV下降40%,TLC下降10%。
结论:肺减容术是治疗晚期肺气肿安全、有效地方法,22例患者无手术死亡,术后肺气肿患者的主观症状及肺功能指标均得到明显改善。胸腔镜肺减容术疗效可靠、创伤小、痛苦轻、恢复美容效果好,逐渐得到患者及医生的青睐,但由于缺乏完善、长期及大样本的随访资料,对于肺减容术的长期疗效以及持续时间的分析有待进一步研究。
Objective : To summarize the clinical experience in the treatment of late- stage emphysema by lung volume reduction surgery(LVRS).
Methods : The follow-up date of 22 patients with severe emphysema underwent LVRS were analyzed retrospectively between May 2009 to December 2010, All the LVES with Pair trachea cannula, The general anesthesia, ALL with the one-sided surgery, 17 LVES with VATS or VATS assited surgery, 5 LVES with standard, flank margin surgery. The destructive and dysfunction pulmonary tissue by linear stapler cut and gives the biological protein adhesive trap needle eye.
Results:After the LVRS, non-spontaneous pneumothorax recrudescence, non-surgery death. The scant of breath symptom reduces obviously, after the LVRS, before in March examines the courage vigor analysis to compare the LVRS, the artery blood oxygen partial pressure to rise 17mmHg, FEV1 to increase 57%, RV equally to drop 40%, TLC to drop 10%.
Conclusions : The LVRS is a security, effectively the method treats the later period pulmonary emphysema, 22 example patient non-surgery death, after the surgery, the pulmonary emphysema patient's subjective symptom and the lung function target have the distinct improvement. The VATS allows the surgery wound to be small, the pain light, restores the cosmetology effect to be good, obtains the patient and doctor's favor gradually, but because lacks the consummation, long-term and the big sample revisit material, the curative effect as well as the duration analysis regarding the lung of LVES waits for further studying.
研究方法:回顾性分析2009年5月到2010年12月我院22例肺减容术患者的临床资料。22例患者均行双腔气管插管,全身麻醉,均为单侧手术,其中胸腔镜或辅助小切口肺减容术17例,标准后外侧切口肺减容术5例。均采用直线切割闭合器切除过度膨胀而破坏的肺组织,并予生物蛋白胶封堵针眼。
结果:患者术后无自发性气胸复发,无手术死亡。呼吸困难症状明显减轻,术后三月检测血气分析较术前动脉血氧分压平均上升17mmHg,FEV1增加57%,RV下降40%,TLC下降10%。
结论:肺减容术是治疗晚期肺气肿安全、有效地方法,22例患者无手术死亡,术后肺气肿患者的主观症状及肺功能指标均得到明显改善。胸腔镜肺减容术疗效可靠、创伤小、痛苦轻、恢复美容效果好,逐渐得到患者及医生的青睐,但由于缺乏完善、长期及大样本的随访资料,对于肺减容术的长期疗效以及持续时间的分析有待进一步研究。
Objective : To summarize the clinical experience in the treatment of late- stage emphysema by lung volume reduction surgery(LVRS).
Methods : The follow-up date of 22 patients with severe emphysema underwent LVRS were analyzed retrospectively between May 2009 to December 2010, All the LVES with Pair trachea cannula, The general anesthesia, ALL with the one-sided surgery, 17 LVES with VATS or VATS assited surgery, 5 LVES with standard, flank margin surgery. The destructive and dysfunction pulmonary tissue by linear stapler cut and gives the biological protein adhesive trap needle eye.
Results:After the LVRS, non-spontaneous pneumothorax recrudescence, non-surgery death. The scant of breath symptom reduces obviously, after the LVRS, before in March examines the courage vigor analysis to compare the LVRS, the artery blood oxygen partial pressure to rise 17mmHg, FEV1 to increase 57%, RV equally to drop 40%, TLC to drop 10%.
Conclusions : The LVRS is a security, effectively the method treats the later period pulmonary emphysema, 22 example patient non-surgery death, after the surgery, the pulmonary emphysema patient's subjective symptom and the lung function target have the distinct improvement. The VATS allows the surgery wound to be small, the pain light, restores the cosmetology effect to be good, obtains the patient and doctor's favor gradually, but because lacks the consummation, long-term and the big sample revisit material, the curative effect as well as the duration analysis regarding the lung of LVES waits for further studying.
引文
1.谢俊刚,徐永健国内外COPD流行病学进展[J].中国实用内科杂志,2006,26(18):1401-1403。
2.Brantigan OC,Mueller E.Surgical treatment of pulmonary emphy-sema[J]. Am Surg,1957,23(9):789—804.
3.Cooper J D, Trulock E P, Triantafillou AN,etal.Bilateral pneumoec-tomy(volume reduction)for chronic obstructive pulmonarydisease[J]. J Thorac Cardiovasc Surg,1995,109(1):106-109.
4.中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南[J].中华结核和呼吸杂志,2007,30(1):8-17.
5. Naunheim KS,Keller CA,Km cylak PE,et a1.Video-assisted thoracic surgical lung reduction[J].Ann Thorac Surg,1996,61(4):1092-8.
6.W akabayashi A,Brenner M ,kayaleh RA,et a1.Thoracoscopic carbon dioxide laser treatment of bullous emphysema[J].The Lancet,1991,337(8746):881-883.
7. Alan MF.Lung Volume reduction surgery(answering the crucial qnestion)[J]. chest,1998,113:277- 278
8.姜格宁,丁喜安,童稳圃,等.肺减容术治疗重度肺气肿43例疗效分析[J].中华胸心管外科杂志,2002,18(5):287—289.
9.Lowdermilk G A, Keenan R J, Landreneau R J,etal. Comparasion of clinical results of unilateral and bilateralthorascopic lung volume reduction [J]. Ann Thorac Surg,2003,69(6):1670-1674.
10.刘德若,赵凤瑞,石彬,等.肺减容术后肺漏气的处理[J].吉林医学, 2003,24(3): 227-229.
11.郎保平,张晓.不同材料在预防肺减容术后肺漏气方面的应用比较[J].中国误诊学杂志.2009,9(24):5865-5866.
12.李辉胸外科学[M],北京:北京大学出版社,2009。
13.Kurnarp, Bush P, George P, et a1.Tracheobronchail Obstruction in children:experience with endoscopic sirway stenting[J].Ann Thorac Surg,2003,75:1579—158O.
14. Obey IF, Michael DL, Morgan, et a1.The Long-term helth status improvements seen afterlung volume reduction surgey[J].EurJ Cardiothorac Surg,2003,24(4):614—619.
15.Mayers BF, Yusen RD,Lefrak SS,et al.Outcome ofmedicare patients with emphysema selected for , butdenied a lung volume reduction operation [J]. AnnThorac Surg,1998,66(2):331—336.
16.张录民,赵维1,杨瑞光.老年肺气肿同期双侧开胸肺大泡切除肺减容术的临床应用研究[J].中国老年学杂志,2009,19:2439-03.
17.郑如恒.胸外科手术规范操作与专家点评[M].北京:人民卫生出版社,2011
1.何建行.对微创胸外科几个问题的再认识[J].中华外科杂志2007,45(22):1515-1517.
2.李辉.胸外科学[M].北京大学出版社,2009,456.
3.冯远景.2008国际微创胸外科手术论坛会议纪要[J].中国胸心血管外科临床杂志,2008,15(6):401.
4.徐驰,初向阳,薛志强,张连斌.电视胸腔镜诊治胸外伤的进展[J].实用临床医药杂志,2010,l4(l):13-15.
5.陈伟.急诊电视胸腔镜在血气胸诊治中的临床应用[J].实用临床医药杂志,2010,14(1):33-36.
6.Martinez M,Briz J E,Carrillo E H.Video thoracoscopy expedites the diagnosis and treatment of penetrating diaphragmatic injuries[J].Surg Endosc,2001,15:28.
7.FelicianoDV, CrusePA, MattoxK L,eta1.Delayeddiagnosis of injuries to the diaphragm after penetrating wounds[J].J TraUlTIa,1988,28:1135.
8.Spann J C, Nwariaku F E,W ait M .Evaluation of videoassisted thoracoscopic surgery in the diagnosis of diaphragmaticinjuries[J].Am J Surg,1995,170(6):628-30.
9.Freeman R K,A1DossariG,HutehesonK A,et a1.Indications for using videoassisted thoracoscopic surgery to diagnose diaphragmatic injuries after penetrating chest trauma[J].Ann Thorac SuN ,2001,72:342.
10.Ivatury R R.The ro1e of laparoscopy in establishing diaphragmatic injury in lower chest wounds [J]. J Trauma,2005,58:1305.
11.严振球,袁延才.VATS微创重点肋骨内固定治疗连枷胸的临床分析[J].临床军医杂志,2009,37(6):1143-1144.
12.刘家荣.胸腔镜手术治疗急性脓胸30例临床观察[J].中国现代药物应用.2010,4(5):61-62.
13.阿布力米提,陈康,努尔兰,马金山.电视胸腔镜(VATS)和传统开胸手术治疗急性脓胸的疗效比较[J].北京医学,2010,32(7):531-533.
14.刘汉忠,彭清臻,田齐凯.胸腔镜胸膜活检在不明原因胸腔积液中的应用[J].中国监床实用医学,2009,3(1):115.
15.殷宗宝,陈彦凡,陈少贤,叶进燕.内科胸腔镜对不明原因胸腔积液的诊断价值[J].浙江临床医学,2008,10(12):1541-1543.
16.晏进,郝建宏,郑直,张群伟.胸腔镜下滑石粉胸膜固定术治疗恶性胸腔积液疗效分析[J].浙江临床医学,2010,12(6):568-569.
17.陈艾江,王华,张明明,等.胸腔镜内脏神经切断术的临床应用体会[J].临床医学,2010,04.
18. Kusano T.Thorascopic thoracic splanchnicectomy for chronic Pancreatitis with intractable abdominal pain[J].Surg Laparosc Endosc,1997,7(3):213-8.
19. Noppen M,Meysman M,D’Hases J,et a1.Thoracoscopic splan chnicolysis for the relief of chronic Pancreatitis pain[J].Chest,1998,113(2):528-31.
20.苏春勇.针形胸腔镜下胸交感神经干切断术治疗手汗症22例分析[J].中国误诊学杂志,2O10, 10(l9):4379.
21. Gossot D,Kabiri H,Caliandro R,et a1.Early complications ofthoracic endoscopic sympathectomy: a prospective study of 940procedures [J]. Ann Thorac Surg,2001,71(4):l116-lll9.
22.范江,姜格宁.胸腔镜的应用及现状[J].中国医师进修杂志,2O08,,31(4):13-15.
23.刘桐林,丁伟.胸部疾病电视胸腔镜诊断治疗学[M].上海:上海科学技术出版社,2003:517-518..
24.罗玉忠,何巍,廖寿合.电视胸腔镜手术与开胸手术治疗自发性气胸的对比研究[J].微创医学,2010,5(3):214-215.
25.李伟阳,王厚强,周建平等.胸腔镜肺减容术治疗重度肺气肿的临床疗效[J].实用医学杂志, 2010,26(16):2975-2976.
26.刘惠萍,晁栋,李乃斌等.电视胸腔镜手术和开胸手术治疗肺癌的创伤性比较[J].第四军医大学学报.,2008,29(23):2186-2188.
27.梁忠诚,梁雄斌,钟源波.电视胸腔镜辅助小切口肺叶切除术临床分析[J].中华现代外科学杂志, 2009,6(3):162-164.
28.陈铭,赵珩,陈文虎.电视胸腔镜技术治疗肺部疾病505例分析[J].中国临床医学.,2009,16(1):56-60.
29.何建行,刘会平,杨运有.电视胸腔镜肺癌根治术5年临床疗效[J].中国胸心血管外科临床杂志,2002,9(1):2930.
30.孙学利.VATS肺叶切除术的现状及进展[J] .实用肿瘤学杂志,2009,23(1):95-97.
31.梁雄斌,陈汉章,吴哲凡等.电视胸腔镜辅助小切口肺癌袖状切除的可行性[J].广东医学,2010,3l(4):451-453.
32.Patti MG,Fisichella PM,Perretta S,et a1. Impact of minimallyinvasive surgery on the treatment of esophag~ achalasia:a decade of changel[J].J Am Coll Surg,2003,196(5):698-705.
33.李怀业,王锦光.电视胸腔镜下行食管肌层切开手术治疗贲门失弛缓症32例[J] .临床军医杂志,2010,38(2):165,228.
34.陈海泉,周建华,曹勇,等.微创食管切除术[J].中国癌症杂志,2006,16(5):385—387.
35.徐宝川,徐美青,魏大中,马冬春.电视胸腔镜下食管癌根治术治疗中、上段食管癌16例分析[J].安徽医药,2010 ,14(7):804-805.
36.王志刚.匹茨堡大学医学中心腔镜微创食管切除术101例临床分析[J].广东医学院学报,2010,28(1):20-22.
37.崔有斌,王凯忠,李博等.电视纵隔镜检查术临床应用初探[J].吉林医学,2005,26(8):812-813.
38.Tsao K, St Peter SD,Sharp SW, et a1.Current application ofthoracoscopy in children[J].Laparoendosc Adv Surg Tech A,2008,18(1):131—135.
39.姜杰,傅成国,杜好信,等.胸腔镜辅助小切口手术150例的临床应用[J].中国微创外科杂志,2007,7(11):1106—1107.
40.胡建才,殷桂林,朱水波,等.电视胸腔镜手术207例报告[J].中国微创外科杂志,2005,5(8):623—624.
2.Brantigan OC,Mueller E.Surgical treatment of pulmonary emphy-sema[J]. Am Surg,1957,23(9):789—804.
3.Cooper J D, Trulock E P, Triantafillou AN,etal.Bilateral pneumoec-tomy(volume reduction)for chronic obstructive pulmonarydisease[J]. J Thorac Cardiovasc Surg,1995,109(1):106-109.
4.中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南[J].中华结核和呼吸杂志,2007,30(1):8-17.
5. Naunheim KS,Keller CA,Km cylak PE,et a1.Video-assisted thoracic surgical lung reduction[J].Ann Thorac Surg,1996,61(4):1092-8.
6.W akabayashi A,Brenner M ,kayaleh RA,et a1.Thoracoscopic carbon dioxide laser treatment of bullous emphysema[J].The Lancet,1991,337(8746):881-883.
7. Alan MF.Lung Volume reduction surgery(answering the crucial qnestion)[J]. chest,1998,113:277- 278
8.姜格宁,丁喜安,童稳圃,等.肺减容术治疗重度肺气肿43例疗效分析[J].中华胸心管外科杂志,2002,18(5):287—289.
9.Lowdermilk G A, Keenan R J, Landreneau R J,etal. Comparasion of clinical results of unilateral and bilateralthorascopic lung volume reduction [J]. Ann Thorac Surg,2003,69(6):1670-1674.
10.刘德若,赵凤瑞,石彬,等.肺减容术后肺漏气的处理[J].吉林医学, 2003,24(3): 227-229.
11.郎保平,张晓.不同材料在预防肺减容术后肺漏气方面的应用比较[J].中国误诊学杂志.2009,9(24):5865-5866.
12.李辉胸外科学[M],北京:北京大学出版社,2009。
13.Kurnarp, Bush P, George P, et a1.Tracheobronchail Obstruction in children:experience with endoscopic sirway stenting[J].Ann Thorac Surg,2003,75:1579—158O.
14. Obey IF, Michael DL, Morgan, et a1.The Long-term helth status improvements seen afterlung volume reduction surgey[J].EurJ Cardiothorac Surg,2003,24(4):614—619.
15.Mayers BF, Yusen RD,Lefrak SS,et al.Outcome ofmedicare patients with emphysema selected for , butdenied a lung volume reduction operation [J]. AnnThorac Surg,1998,66(2):331—336.
16.张录民,赵维1,杨瑞光.老年肺气肿同期双侧开胸肺大泡切除肺减容术的临床应用研究[J].中国老年学杂志,2009,19:2439-03.
17.郑如恒.胸外科手术规范操作与专家点评[M].北京:人民卫生出版社,2011
1.何建行.对微创胸外科几个问题的再认识[J].中华外科杂志2007,45(22):1515-1517.
2.李辉.胸外科学[M].北京大学出版社,2009,456.
3.冯远景.2008国际微创胸外科手术论坛会议纪要[J].中国胸心血管外科临床杂志,2008,15(6):401.
4.徐驰,初向阳,薛志强,张连斌.电视胸腔镜诊治胸外伤的进展[J].实用临床医药杂志,2010,l4(l):13-15.
5.陈伟.急诊电视胸腔镜在血气胸诊治中的临床应用[J].实用临床医药杂志,2010,14(1):33-36.
6.Martinez M,Briz J E,Carrillo E H.Video thoracoscopy expedites the diagnosis and treatment of penetrating diaphragmatic injuries[J].Surg Endosc,2001,15:28.
7.FelicianoDV, CrusePA, MattoxK L,eta1.Delayeddiagnosis of injuries to the diaphragm after penetrating wounds[J].J TraUlTIa,1988,28:1135.
8.Spann J C, Nwariaku F E,W ait M .Evaluation of videoassisted thoracoscopic surgery in the diagnosis of diaphragmaticinjuries[J].Am J Surg,1995,170(6):628-30.
9.Freeman R K,A1DossariG,HutehesonK A,et a1.Indications for using videoassisted thoracoscopic surgery to diagnose diaphragmatic injuries after penetrating chest trauma[J].Ann Thorac SuN ,2001,72:342.
10.Ivatury R R.The ro1e of laparoscopy in establishing diaphragmatic injury in lower chest wounds [J]. J Trauma,2005,58:1305.
11.严振球,袁延才.VATS微创重点肋骨内固定治疗连枷胸的临床分析[J].临床军医杂志,2009,37(6):1143-1144.
12.刘家荣.胸腔镜手术治疗急性脓胸30例临床观察[J].中国现代药物应用.2010,4(5):61-62.
13.阿布力米提,陈康,努尔兰,马金山.电视胸腔镜(VATS)和传统开胸手术治疗急性脓胸的疗效比较[J].北京医学,2010,32(7):531-533.
14.刘汉忠,彭清臻,田齐凯.胸腔镜胸膜活检在不明原因胸腔积液中的应用[J].中国监床实用医学,2009,3(1):115.
15.殷宗宝,陈彦凡,陈少贤,叶进燕.内科胸腔镜对不明原因胸腔积液的诊断价值[J].浙江临床医学,2008,10(12):1541-1543.
16.晏进,郝建宏,郑直,张群伟.胸腔镜下滑石粉胸膜固定术治疗恶性胸腔积液疗效分析[J].浙江临床医学,2010,12(6):568-569.
17.陈艾江,王华,张明明,等.胸腔镜内脏神经切断术的临床应用体会[J].临床医学,2010,04.
18. Kusano T.Thorascopic thoracic splanchnicectomy for chronic Pancreatitis with intractable abdominal pain[J].Surg Laparosc Endosc,1997,7(3):213-8.
19. Noppen M,Meysman M,D’Hases J,et a1.Thoracoscopic splan chnicolysis for the relief of chronic Pancreatitis pain[J].Chest,1998,113(2):528-31.
20.苏春勇.针形胸腔镜下胸交感神经干切断术治疗手汗症22例分析[J].中国误诊学杂志,2O10, 10(l9):4379.
21. Gossot D,Kabiri H,Caliandro R,et a1.Early complications ofthoracic endoscopic sympathectomy: a prospective study of 940procedures [J]. Ann Thorac Surg,2001,71(4):l116-lll9.
22.范江,姜格宁.胸腔镜的应用及现状[J].中国医师进修杂志,2O08,,31(4):13-15.
23.刘桐林,丁伟.胸部疾病电视胸腔镜诊断治疗学[M].上海:上海科学技术出版社,2003:517-518..
24.罗玉忠,何巍,廖寿合.电视胸腔镜手术与开胸手术治疗自发性气胸的对比研究[J].微创医学,2010,5(3):214-215.
25.李伟阳,王厚强,周建平等.胸腔镜肺减容术治疗重度肺气肿的临床疗效[J].实用医学杂志, 2010,26(16):2975-2976.
26.刘惠萍,晁栋,李乃斌等.电视胸腔镜手术和开胸手术治疗肺癌的创伤性比较[J].第四军医大学学报.,2008,29(23):2186-2188.
27.梁忠诚,梁雄斌,钟源波.电视胸腔镜辅助小切口肺叶切除术临床分析[J].中华现代外科学杂志, 2009,6(3):162-164.
28.陈铭,赵珩,陈文虎.电视胸腔镜技术治疗肺部疾病505例分析[J].中国临床医学.,2009,16(1):56-60.
29.何建行,刘会平,杨运有.电视胸腔镜肺癌根治术5年临床疗效[J].中国胸心血管外科临床杂志,2002,9(1):2930.
30.孙学利.VATS肺叶切除术的现状及进展[J] .实用肿瘤学杂志,2009,23(1):95-97.
31.梁雄斌,陈汉章,吴哲凡等.电视胸腔镜辅助小切口肺癌袖状切除的可行性[J].广东医学,2010,3l(4):451-453.
32.Patti MG,Fisichella PM,Perretta S,et a1. Impact of minimallyinvasive surgery on the treatment of esophag~ achalasia:a decade of changel[J].J Am Coll Surg,2003,196(5):698-705.
33.李怀业,王锦光.电视胸腔镜下行食管肌层切开手术治疗贲门失弛缓症32例[J] .临床军医杂志,2010,38(2):165,228.
34.陈海泉,周建华,曹勇,等.微创食管切除术[J].中国癌症杂志,2006,16(5):385—387.
35.徐宝川,徐美青,魏大中,马冬春.电视胸腔镜下食管癌根治术治疗中、上段食管癌16例分析[J].安徽医药,2010 ,14(7):804-805.
36.王志刚.匹茨堡大学医学中心腔镜微创食管切除术101例临床分析[J].广东医学院学报,2010,28(1):20-22.
37.崔有斌,王凯忠,李博等.电视纵隔镜检查术临床应用初探[J].吉林医学,2005,26(8):812-813.
38.Tsao K, St Peter SD,Sharp SW, et a1.Current application ofthoracoscopy in children[J].Laparoendosc Adv Surg Tech A,2008,18(1):131—135.
39.姜杰,傅成国,杜好信,等.胸腔镜辅助小切口手术150例的临床应用[J].中国微创外科杂志,2007,7(11):1106—1107.
40.胡建才,殷桂林,朱水波,等.电视胸腔镜手术207例报告[J].中国微创外科杂志,2005,5(8):623—624.