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目的 评价肺通气/灌注(V/P)显像对慢性阻塞性肺病(COPD)肺容积减少术(LVRS)病例的选择及手术部位和范围确定的价值。方法 128例COPD患者(均为男性,年龄45～76岁)进行V/P显像,其中29例(年龄45～74岁)进行LVRS治疗,术后3～6个月复查。通气显像采用99Tcm-DTPA气溶胶吸入法,灌注显像用99Tcm-人血清聚合白蛋白(MAA)静注法。根据显像类型分成①局灶型:即肺内放射性分布不均匀,局部肺组织有明显分布稀疏缺损区,而其他部位相对较好;②弥漫型:即两肺内放射性弥漫性稀疏缺损。结果 LVRS治疗的29例患者V/P显像均呈局灶型,外科根据显像所提示的局部病变部位及范围进行手术,术后3～6个月患者肺功能均得到明显改善,手术前后1 s用力呼气容积占用力肺活量比值(FEV1.0%)分别为(35.88±6.27)%与(66.15±3.99)%,t=3.986,P<0.001。结论 V/P显像对COPD进行LVRS治疗的手术病例选择及手术部位和范围的确定具有重要的参考价值。“,”Objective To evaluate the importance of lung ventilation/perfusion scintigraphy (V/P) in selection of patients with chronic obstructive pulmonary disease (COPD) for lung volume reduction surgery (LVRS) and to determine the foci and the amount of lung to be resected during surgery. Methods V/P was used in 128 patients (all men; age range 45～76 years) with COPD. Among the 128 patients, 29 (age rang 45～74 years) were selected for LVRS. The V/P was performed using 99 Tcm-DTPA aerosol and 99 Tcm-MAA, respectively. Heterogeneity was defined as the regional variation in the severity of emphysema throughout the lungs, with localization indicative of target areas of severely emphysematous lung among areas of mild emphysema and with diffusion indicative of diffuse emphysema throughout the lungs, with all regions similarly affected. Results Patients selected for LVRS all showed severely heterogeneous pattern. The V/P results were used to guide the LVRS. After operation, the forced expiratory volume for 1 second (FEV1.0%) was significantly improved. Before and after LVRS, the FEV1.0% was (35.88±6.27)% vs (66.15±3.99)% (t=3.986, P<0.001). Conclusions The V/P aids the thoracic surgeon in selecting LVRS candidates and in determining the foci and the amount of lung to be resected during surgery.