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胸腔镜肺大疱切除术治疗巨型肺大疱伴中重度肺功能减低的疗效

Efficacy of thoracoscopic pulmonary bulla resection in treating giant emphysematous bulla complicated with moderate to severe pulmonary hypofunction

    摘要
  • 摘要:
    目的 观察单孔和双孔胸腔镜下肺大疱(PB)切除术治疗巨型肺大疱(GEB)伴中重度肺功能减低患者的临床效果。
    方法 将GEB伴肺功能中重度减低患者92例随机分为研究组46例(采用单孔胸腔镜下PB切除术治疗)和对照组46例(采用双孔胸腔镜下PB切除术治疗)。比较2组手术情况、术后康复情况、肺功能指标第1秒用力呼气量占预计值百分比(FEV1%)、最大通气量占预计值百分比(MVV%)、动脉血气指标动脉血氧分压pa(O2)、动脉血二氧化碳分压pa(CO2)、血清炎性因子C反应蛋白(CRP)、白细胞介素-6(IL-6)、转化生长因子β受体1(TβR1)、成纤维细胞生长因子10(FGF-10)水平、6 min步行距离(6 MWD)、圣乔治呼吸问卷(SGRQ)评分、并发症发生率、复发率。
    结果 研究组出血量、胸腔引流量少于对照组，术后带管时间、住院时间短于对照组，差异有统计学意义(P < 0.05); 研究组术后1周血清CRP、IL-6、TβR1、FGF-10水平均低于对照组，差异有统计学意义(P < 0.05); 2组术后6个月FEV1%、MVV%、pa(O2)高于术前, pa(CO2)低于术前，差异有统计学意义(P < 0.05); 2组术后6个月6 MWD、SGRQ评分高于术前，差异有统计学意义(P < 0.05); 研究组并发症发生率为8.70%, 低于对照组的23.91%, 差异有统计学意义(P < 0.05); 2组术后12个月内复查术侧胸部CT, 均无PB复发病例。
    结论 胸腔镜下PB切除术治疗中重度肺功能减低GEB患者，可提高患者肺功能，改善生活质量。单孔胸腔镜手术能进一步减轻手术创伤，降低并发症发生率，促进术后康复。

     

    Abstract:
    Objective To observe the clinical effects of single- and double-port thoracoscopic pulmonary bulla (PB) resection in the treatment of giant emphysematous bulla (GEB) patients with moderate to severe pulmonary hypofunction.
    Methods A total of 92 GEB patients with moderate to severe pulmonary hypofunction were randomly divided into study group with 46 cases (treated with single-port thoracoscopic PB resection) and control group with 46 cases (treated with double-port thoracoscopic PB resection). Surgical condition, postoperative recovery, pulmonary function indexes forced expiratory volume in the first second as a percentage (FEV1%), maximal ventilatory volume as a percentage (MVV%), arterial blood gas indexes arterial partial pressure of oxygen pa(O2), arterial partial pressure of carbon dioxide pa(CO2), serum inflammatory factors C-reactive protein (CRP), interleukin-6 (IL-6), transforming growth factor β receptor 1 (TβR1), fibroblast growth factor-10 (FGF-10), 6 minutes walking distance (6 MWD), St. George′s Respiratory Questionnaire (SGRQ) score, incidence of complications and recurrence rate were compared between two groups.
    Results The bleeding volume and thoracic drainage volume in the study group were significantly less than those in the control group, and the postoperative catheterization time and hospital stay were significantly shorter than those in the control group (P < 0.05); the serum levels of CRP, IL-6, TβR1 and FGF-10 in the study group were significantly lower than those in the control group at 1 week after operation (P < 0.05); the FEV1%, MVV% and pa(O2) in both groups at 6 months after operation were significantly higher than those before operation, while pa(CO2) was significantly lower than that before operation (P < 0.05); the 6 MWD and SGRQ score at 6 months after operation in both groups were significantly higher than those before operation (P < 0.05); the incidence of complications in the study group was 8.70%, which was significantly lower than 23.91% in the control group (P < 0.05); there was no case with recurrence of PB in both groups after re-examination of chest CT on the operation side within 12 months after operation.
    Conclusion For GEB patients with moderate to severe pulmonary hypofunction, thoracoscopic PB resection can significantly improve patient's lung function and quality of life. Single-port thoracoscopic surgery can further alleviate surgical trauma, and reduce the incidence of complications and promote postoperative recovery.

     

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