摘要
目的前瞻性研究电视胸腔镜手术(VATS)与常规开胸肺减容手术治疗慢性阻塞性肺气肿的疗效,总结更适合该类患者的手术治疗方法。方法 30例高龄慢性阻塞性肺气肿患者随机分组,分别采用VATS和常规开胸单侧肺减容手术治疗,比较其近远期疗效,肺功能、血气分析及血清细胞因子IL-1和TNF-α的变化。结果该组无死亡病例,均治愈出院。随访2年,VATS组与传统开胸组围术期临床指标的差异有显著性(P<0.05),VATS组胸管留置的时间及镇痛剂使用的时间短,术中出血量少,出院早;术后2dIL-1和TNF-α开胸手术组较VATS组显著升高(P<0.05);术后3个月FEV1、TLC、RV、PO2及6MWD的改善程度VATS组优于开胸手术组(P<0.05),术后24个月FEV1、TLC、RV、PO2及6MWD的改善程度VATS组和开胸手术组差异无显著性(P>0.05)。结论 VATS肺减容手术治疗重度慢性阻塞性肺气肿患者的近期疗效优于传统开胸手术,远期疗效相似。
[Objective] To make a comparative study of clinical efficacy of video-assisted thoracoscopic surgery （VATS） and conventional open chest lung volume reduction surgery for the treatment of chronic obstructive pulmonary emphysema. [Methods] Consecutive 30 elderly patients with chronic obstructive pulmonary emphysema were randomly entered into video-assisted thoracoscopic surgery （VATS） group and conventional thoracotomy unilateral lung volume reduction surgery group. The short-term and long-term curative effect, lung function, blood gas analysis and serum cytokines IL-1 and TNF-α were compared. [Results] There was no death in either group. All the patients were discharged and followed up for two years. The peri-operative clinical indicators in VATS group was significantly different from that in the traditional thoracotomy group （P 0.05）. In the VATS group there were less chest tube time, analgesic time and bleeding, and the patients were discharged earlier from hospital. The IL-1 and TNF-α levels 2 days after operation were significantly higher in thoracotomy group than the VATS group （P 0.05）, the degree of improvement in FEV1, TLC, RV, PO2 and 6MWD 3 months after operation was higher in the VATS group than in the thoracotomy group （P 0.05）, the degree of improvement in FEV1, TLC, RV, PO2 and 6MWD 24 months after operation in the VATS group was not significantly different from that in the thoracic surgery group （P 0.05）. [Conclusions] VATS lung volume reduction surgery in patients with severe chronic obstructive pulmonary emphysema is more effective than the traditional thoracotomy, but they have similar long-term effects.
出处
《中国内镜杂志》
CSCD
北大核心
2013年第5期449-453,共5页
China Journal of Endoscopy
基金
the Medical Science and Technology Development Fund of Nanjing City(No.ykk09069)
关键词
电视胸腔镜
慢性阻塞性肺气肿
肺减容术
video-assisted thoracoscopic surgery
chronic obstructive pulmonary disease
lung volume reduction surgery
