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目的评价在肺或食管肿瘤手术中同期行肺减容术(LVRS)的可行性和效果。方法 45例肺肿瘤和37例食管肿瘤病人,随机分为甲组和乙组,甲组在肿瘤切除手术中同期行开胸侧 LVRS,根据术前胸部 CT、灌注通气肺扫描结果,确定肺无功能区,切除一侧肺叶的20%～30%;乙组为单纯肿瘤切除术组。随访6～12个月,对比手术前、后肺功能、血气、呼吸困难指数、6 min 行走距离(6MWD)等指标。结果两组均无围术期死亡,术后 FEV_1、PaO_2、PaCO_2、呼吸困难指数以及6MWD 甲组病人较术前改善,乙组较术前变化不明显或有轻度下降。结论对合并肺气肿的肿瘤病人,同期 LVRS 不仅增加了病人的手术机会,而且提高了病人术后生活质量。LVRS 扩大了肿瘤病人的手术适应证。
Objective To evaluate the feasibility and effectiveness of simultaneous lung volume reduction (LVRS) in lung or esophageal cancer surgery. Methods Forty-five patients with lung cancer and 37 patients with esophageal neoplasm were randomly divided into two groups: group A and group B. Patients in group A underwent resection of thoracic LVRS at the same time. According to preoperative CT chest CT and perfusion ventilation lung scan, Functional area, removal of the side of the lung 20% to 30%; Group B was a simple tumor resection group. The patients were followed up for 6 to 12 months, and the indexes of lung function, blood gas, dyspnea index and 6MWD distance before and after surgery were compared. Results There was no perioperative death in both groups. The FEV 1, PaO 2, PaCO 2, index of dyspnea, and 6MWD group A patients were better than those before operation. There was no obvious or slight decrease in group B compared with that before operation. Conclusions For the patients with emphysema, patients with LVRS during the same period not only increased the chance of operation, but also improved the postoperative quality of life. The LVRS expands the surgical indication for cancer patients.