[1]沈明敬,徐中华,陈勇兵,等.胸腔镜手术治疗消失肺综合征[J].中国微创外科杂志,2017,17(5):411-414.
　Shen Mingjing,Xu Zhonghua,Chen Yongbing,et al.Treatment of Vanishing Lung Syndrome with Video Assisted Thoracoscopic Surgery[J].Chinese Journal of Minimally Invasive Surgery,2017,17(5):411-414.
点击复制

胸腔镜手术治疗消失肺综合征()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
17
期数:
2017年5期
页码:
411-414
栏目:
临床研究
出版日期:
2017-07-14

文章信息/Info

Title:
Treatment of Vanishing Lung Syndrome with Video Assisted Thoracoscopic Surgery
作者:
沈明敬; 徐中华; 陈勇兵; 徐卫华; 徐忠恒*
苏州大学附属第二医院胸心外科，苏州215004
Author(s):
Shen Mingjing;  Xu Zhonghua;  Chen Yongbing;  et al.
Department of Thoracic-cardio Surgery, Second Affiliated Hospital of Soochow University, Suzhou 215004, China
关键词:
消失肺综合征; 巨型肺大疱; 胸腔镜手术; 肺减容术; 肺功能
Keywords:
Vanishing lung syndrome; Giant pulmonary bulla; Video assisted thoracoscopic surgery; Lung volume reduction surgery; Lung function
文献标志码:
A
摘要:
目的探讨胸腔镜手术治疗消失肺综合征（vanishing lung syndrome，VLS）的效果。方法2008年9月~2015年3月我们对16例VLS根据手术难度行胸腔镜单孔、两孔、三孔手术。有粘连者首先松解粘连，探明肺大疱位置，设计切割方向、顺序，切割肺大疱，反复膨肺观察完成切割并修补漏气点，置引流管，关闭创口，术毕。对术前与术后3个月第1秒用力呼吸量（forced expiratory volume in one second,FEV1）、肺总量（total lung capacity,TLC）、残气量（residual volume,RV）进行对比分析。结果7例分期行双侧胸腔镜下手术，间隔时间6~15个月，中位时间10个月；2例双侧VLS拒绝双侧手术仅行单侧手术；7例行单侧手术。共手术23次，其中21次完全胸腔镜下完成手术（单孔法11次，两孔法9次，三孔法1次），2次因胸膜腔粘连在腔镜辅助下小切口手术。手术时间(50.6±12.3)min，术后胸腔引流管留置(12.4±4.8)d，术后住院(13.8±5.6)d，住院总费用(5.50±1.63)万元。FEV1术前(0.75±0.32)L，明显低于术后（117±0.45）L（t=-7.654，P=0.000）；RV术前（3.76±0.52）L，明显高于术后（2.85±0.33）L（t=12.284，P=0.000）；TLC术前（5.70±0.56）L，明显高于术后（4.88±0.47）L（t=5.187，P=0.000）；PaO2术前（60.2±9.0) mm Hg，明显低于术后(71.5±10.3) mm Hg（t=-9.892，P=0.000）；PaCO2术前（49.7±11.6) mm Hg，明显高于术后(42.6±8.8) mm Hg（t=3908，P=0.000）。术后发生房颤2例，给予西地兰、胺碘酮纠正；肺部感染4例，经验性或痰培养结果升级抗生素等级治愈；肺漏气>1周17例，时间8~20 d，中位漏气时间12 d；颈胸腹壁大范围皮下气肿9例；围手术期未发生死亡、呼吸功能衰竭等手术并发症。结论胸腔镜肺大疱切除或肺减容术治疗VLS安全性高，微创，能显著提高患者肺功能。
Abstract:
ObjectiveTo investigate the efficacy of video assisted thoracoscopic surgery(VATS) for vanishing lung syndrome (VLS). MethodsClinical data of 16 patients suffering VLS between September 2008 and March 2015 were collected. Among them, 7 patients with bilateral VLS underwent bullectomy or lung volume resection surgery (LVRS), and other 9 patients underwent unilateral operation. After anesthesia, single or more incisions were made according to personal situation, after which the bulla were located and cut off. Repeated observation and manipulation were necessary before placing drainage tube and sewing. The results of arterial blood gas analysis (PaO2, PaCO2) and lung function test ［forced expiratory volume in one second (FEV1）,total lung capacity (TLC）,residual volume (RV）］ were checked before and 3 months after operation.ResultsA total of 7 patients accepted bilateral thoracoscopic surgery with interval periods from 6 to 15 months while the other 9 patients accepted unilateral thoracoscopic surgery. There were totally 23 operations, including 21 cases of thoracoscopic surgery and 2 cases of thoracoscopically assisted surgery because of pleural adhesions. The operation time was (50.6±123) min, the duration of chest tube drainage was (12.4±4.8) days, the postoperative hospital stay was (13.8±5.6) days, and the cost of hospitalization was (55.0±16.3) thousand yuan. The preoperative value of FEV1 was (0.75±0.32) L, which was significantly lower than postoperative value ［(1.17±0.45) L, t=-7.654, P=0000］. The preoperative RV was significantly higher than postoperative ［(3.76±0.52) L vs. (2.85±0.33) L, t=12.284, P=0.000］. The preoperative TLC was significantly higher than postoperative ［(5.70±0.56) L vs. (4.88±0.47) L, t=5.187, P=0.000］. The preoperative PaO2 was significantly lower than postoperative ［(60.2±9.0) mm Hg vs. (71.5±10.3) mm Hg, t=-9.892, P=0.000］. And the preoperative PaCO2 was significantly higher than postoperative ［(497±11.6) mm Hg vs. (42.6±8.8) mm Hg, t=3.908, P=0.000］. Postoperatively, atrial fibrillation happened in 2 cases, which were treated with amiodarone and cedilanid. Pulmonary infection occurred in 4 cases, which were given antibiotic treatment according to clinical experience or sputum culture results. Air leakage lasted for more than 1 week in 17 cases, with a duration of 8-20 d (median, 12 d). Extensive subcutaneous emphysema happened in 9 cases. During perioperative period, no death or lung function failure was noted.ConclusionThe treatment of VLS by VATS or LVRS is safe and effective, with minimal invasion and improved lung functions.

参考文献/References:

[1]Roberts L, Putman CE, Chen JTT, et al. Vanishing lung syndrome: upper lobe bullous pneumopathy. Rev Interam Radiol,1987,12(9):249-255.
[2]Burke RM. Vanishing lungs: a case report of bullous emphysema. Radiology,1937,28(3):367-371.
[3]沈利民，陆之安，钱铭辉，等.消失肺综合征的影像学特征（附七例报告）.中华放射学杂志，1995，29（11）：787-789.
[4]Hutchison DCS, Cooper D. Alpha-Ⅰ-antitrypsin deficiency: smoking, decline in lung function and implications for therapeutic trials. Respir Med,2002,96(11):872-880.
[5]Tashtoush B, Gonzalez-Ibarra F, Memarpour R, et al. Vanishing lung syndrome in a patient with HIV infection and heavy marijuana use. Case Rep Pulmonol,2014,28(5):208-212.
[6]何隽祥，黄宝生，高希春，等.家族行消失肺综合征（附一家五例报告）.中华放射学杂志，2002，36（5）：465-466.
[7]曹金鑫，苗劲柏，李辉.细胞因子KL-6、FGF-10、MMP-9在自发性气胸患者肺大疱中的表达及意义.中华胸心血管外科杂志,2014,30（7）:400-403.
[8]Palla A, Desideri M, Rossi G, et al. Elective surgery for giant bullous emphysema: a 5-year clinical and functional follow up. J Chest.2005,128(4):2043-2050.
[9]Gunnarsson SI, Johannesson KB, Gudjonsdottir M, et al. Incidence and outcomes of surgical resection for giant pulmonary bullae-a population-based study. Scand J Surg,2012,101(3):166-169.
[10]黄金穗，吴卫春，孔海红.肺气肿合并气胸行胸腔镜肺减容术呼吸道的管理.中国微创外科杂志，2015，15（5）:478-480.
[11]Huang W, Han R, Li L, et al. Surgery for giant emphysematous bullae: a case report and a short literature review. J Thorac Dis,2014,6(6):E104-E107.
[12]付向宁，张霓，孙威，等.应用自体胸膜治疗肺大皰型肺气肿合并复发性气胸.中华胸心血管外科杂志，2006，22（4）:278.
[13]Van Bael K, La Meir M, Vanoverbeke H. Video-assisted thoracoscopic resection of a giant bulla in vanishing lung syndrome: case report and a short literature review. J Cardiothorac Surg,2014,9:4.
[14]Schipper PH, Meyers BF, Battafarano RJ, et al. Outcomes after resection of giant emphysematous bullae. Ann Thorac Surg,2004,78(3):976-982.

备注/Memo

备注/Memo:
*通讯作者，E-mail：xzho66@sina.com
更新日期/Last Update: 2017-07-14