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目的 总结肺减容术(LVRS)治疗慢性阻塞性肺疾病(COPD)的治疗经验。方法 本组行LVRS 15例,其中同期双侧行LVRS 10例,分期双侧行LVRS 2例,单侧行LVRS 3例。术前根据CT和同位素肺通气灌注扫描选择肺气肿手术“靶区”。术中使用带牛心包垫的直线切割缝合器切除病变,漏气处涂生物蛋白凝胶。结果 术后患者呼吸困难、生活质量、肺功能有较显著改善;呼吸困难指数较术前平均提高1度,单侧行LVRS患者第1秒时间肺活量(FEV1)平均提高30 % ,双侧行LVRS患者FEV1平均提高5 .8% ,术后6个月至1年FEV1改善达到高峰,持续2年后下降。并发症发生率为4 6 . 7%。结论 LVRS可明显改善具有手术适应证的COPD患者的肺功能,提高其生存质量。
Objective To summarize the therapeutic experience of lung volume reduction (LVRS) in the treatment of chronic obstructive pulmonary disease (COPD). Methods The group of patients with LVRS 15 cases, including bilateral LVRS in the same period 10 cases, double staging LVRS in 2 cases, unilateral LVRS in 3 cases. Preoperative emphysema surgery according to CT and isotope lung perfusion scan selection “target area.” Intraoperative use of bovine pericardium pad straight line cutting suture removal of lesions, leaks coated with bio-protein gel. Results The postoperative respiratory dysfunction, quality of life and pulmonary function were significantly improved. The index of dyspnea was increased by 1 degree compared with that before operation. The mean time to failure (FEV1) of LVRS in unilateral patients was increased by 30% In patients with FEV1 average increase of 5.8%, 6 months to 1 year after the improvement of FEV1 reached its peak, continued to decline after 2 years. The complication rate was 46.7%. Conclusions LVRS can significantly improve the lung function and improve the quality of life in COPD patients with surgical indications.