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中华胸部外科电子杂志 ›› 2021, Vol. 08 ›› Issue (04) : 223 -228. doi: 10.3877/cma.j.issn.2095-8773.2021.04.04

论著

单孔胸腔镜肺减容在治疗老年慢性阻塞性肺疾病中的应用
杨彦辉1, 李季1, 王毅1, 罗雷1, 成欣1, 钟霖2, 谢晓阳1,()   
  1. 1. 641000 内江,四川省内江市第一人民医院重庆医科大学附属内江医院胸外科
    2. 610500 成都,成都医学院临床医学系
  • 收稿日期:2021-06-17 修回日期:2021-07-16 接受日期:2021-11-01 出版日期:2021-11-28
  • 通信作者: 谢晓阳

Application of single-port thoracoscopy in the treatment of elderly chronic obstructive pulmonary disease

Yanhui Yang1, Ji Li1, Yi Wang1, Lei Luo1, Xin Cheng1, Lin Zhong2, Xiaoyang Xie1,()   

  1. 1. Department of Thoracic Surgery, The First People’s Hospital of Neijiang, Neijiang Affiliated Hospital of Chongqing Medical University, Neijiang 641000, China
    2. School of Clinical Medicine, Chengdu Medical College, Chengdu 610500, China
  • Received:2021-06-17 Revised:2021-07-16 Accepted:2021-11-01 Published:2021-11-28
  • Corresponding author: Xiaoyang Xie
引用本文:

杨彦辉, 李季, 王毅, 罗雷, 成欣, 钟霖, 谢晓阳. 单孔胸腔镜肺减容在治疗老年慢性阻塞性肺疾病中的应用[J/OL]. 中华胸部外科电子杂志, 2021, 08(04): 223-228.

Yanhui Yang, Ji Li, Yi Wang, Lei Luo, Xin Cheng, Lin Zhong, Xiaoyang Xie. Application of single-port thoracoscopy in the treatment of elderly chronic obstructive pulmonary disease[J/OL]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2021, 08(04): 223-228.

目的

总结单孔胸腔镜治疗老年慢性阻塞性肺疾病的临床经验并观察其疗效。

方法

回顾性分析2016年1月至2020年12月47例单孔胸腔镜肺减容术患者的病例资料,采用stoze电视胸腔镜及切割缝合器切除过度通气肺组织,观察患者术后肺功能、血气变化、6 min步行试验(6-minute walking test,6MWT)变化及术后随访情况。

结果

患者均无围手术期死亡,术后住院时间(13.57±6.94) d,术后带管时间(11.55±6.81) d,术后出现高碳酸血症再次有创呼吸机辅助通气1例,合并肺部感染5例,术后出现广泛皮下气肿再次胸腔闭引流5例。与术前相比,术后5 d、1个月、3个月第1秒用力呼气容积、动脉血氧分压及6MWT均显著好转(P<0.05)。

结论

单孔电视胸腔镜治疗老年慢性阻塞性肺疾病患者,可有效改善肺功能及生活质量,效果显著。

Objective

To summarize the clinical experience of single-port thoracoscopy in the treatment of senile chronic obstructive pulmonary disease (COPD) and observe its curative effect.

Methods

The clinical data of 47 patients who underwent single-port thoracoscopic lung volume reduction surgery from January 2016 to December 2020 were analyzed retrospectively. The hyperventilated lung tissue was removed with the Stoze video-assisted thoracoscopy and cutting suture device. The changes of pulmonary function, blood gas, 6-min walking test (6MWT) and postoperative follow-up were investigated.

Results

There was no perioperative death. The postoperative hospital stay was (13.57±6.94) days, and the postoperative time with tube was (11.55±6.81) days. Postoperative hypercapnia occurred again in 1 case of ventilator-assisted ventilation and 5 cases of pulmonary was infected. Five cases were suffered postoperative extensive subcutaneous emphysema and thoracic closed drainage. Compared with the pre-operation, forced expiratory volume in the first second, arterial partial pressure of oxygen and 6MWT after 5 days, 1 month and 3 months of the surgery were significantly better (all P<0.05) .

Conclusion

Single-port video-assisted thoracoscopy can effectively improve lung function and quality of life in elderly patients with COPD.

图1 患者男性,56岁,吸烟史30+年,右肺行单孔胸腔镜LVRS,术前及术中CT资料
图2 患者男性,68岁,吸烟史40+年,单孔胸腔镜右上肺叶切除+ LVRS术前及术后CT资料
表1 47例肺减容患者术前及术中临床资料
图3 术前及术前3个月FEV1及6MWT比较
表2 所有患者术前和术后肺功能值及6MWT
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