肺大疱切除术联合胸膜固定术治疗老年慢性阻塞性肺疾病顽固性气胸的近、远期疗效-现代医学

肺大疱切除术联合胸膜固定术治疗老年慢性阻塞性肺疾病顽固性气胸的近、远期疗效

单位：攀枝花学院附属医院呼吸科, 四川攀枝花 617000

分类号：R563;R561.4

出版年·卷·期（页码）：2019·47·第十二期（1482-1486）

摘要：

目的： 探讨肺大疱切除术联合胸膜固定术治疗老年慢性阻塞性肺疾病（COPD）顽固性气胸的近期及远期疗效。方法： 选择我院诊断为COPD顽固性气胸的老年患者98例，分为肺大疱切除联合胸膜固定组（A组，50例）和肺大疱切除组（B组，48例）。分别比较两组患者的一般资料，围手术期相关指标，术后不良反应及并发症，术后复发情况，术前、术后2周相关血清学指标和呼吸功能评价指标。采用K-M法进行生存分析。结果： A组术中出血量多于B组，手术时间长于B组，术后引流管留置时间及术后住院时间短于B组，术后持续漏气、胸腔内出血、皮下气肿的发生率低于B组，差异均有统计学意义（P<0.05）。术后2周A组动脉血氧分压（PaO₂）、用力肺活量（FVC）、一秒用力呼气容积占预计值百分比（FEV₁%）低于B组，动脉血二氧化碳分压（PaCO₂）、慢性阻塞性肺疾病评估测试（CAT）评分高于B组，差异均有统计学意义（P<0.05）。A组近期复发率（2.00%）低于B组（14.58%）（P<0.05），远期复发率A组（22.92%）与B组（21.74%）相近（P>0.05）。A组生存率（89.58%）低于B组（95.65%），但差异无统计学意义（P>0.05）。结论： 胸腔镜肺大疱切除术联合胸膜固定术与单纯肺大疱切除术相比，可取得较满意的近期疗效，但并不能取得良好的远期疗效。

Objective: To investigate the short-term and long-term effects of pulmonary bulla resection combined with pleurodesis versus pulmonary bulla resection in the treatment of elder chronic obstructive pulmonary disease (COPD) with intractable pneumothorax. Methods: A total of 98 patients diagnosed as COPD with intractable pneumothorax were enrolled. They were divided into the pulmonary bulla resection combined with pleurodesis group (group A, n=50) and the pulmonary bulla resection group (group B, n=48). The general data, perioperative related indicators, postoperative adverse reactions and complications, postoperative recurrence, serological and respiratory function evaluation indexes before and 2 weeks after surgery were compared. The survival analysis was performed by K-M method. Results: In group A, the intraoperative blood loss, operation time were more than group B,postoperative drainage tube indwelling time and postoperative hospital stay were shorter than those in group B. The incidence of continuous air leak, intrathoracic hemorrhage and subcutaneous emphysema in group A was lower than those in group B. Two weeks after operation, the values of partial pressure of oxygen (PaO₂), forced vital capacity (FVC), forced expiratory volume in the first second as a percentage of the expected value(FEV1%) in group A were lower than those in group B, and the values of partial pressure of carbon dioxide in artery (PaCO₂) and COPD assessment test (CAT) were higher than those in group B. The above differences were statistically significant (P<0.05). The short-term recurrence rate in group A (2.00%) was lower than that in group B (14.58%), the difference was statistically significant (P<0.05). The long-term recurrence rate in group A (22.92%) was similar to that in group B (21.74%), there was no statistical significance (P>0.05). The survival rate of group A (89.58%) was lower than that of group B (95.65%), but the difference was not statistically significant (P>0.05). Conclusion: In the treatment of COPD intractable pneumothorax, pulmonary bulla resection combined with pleurodesis can achieve satisfactory short-term results, but long-term results are not ideal compared with pulmonary bulla resection.

参考文献：

[1] GALVEZ C,BOLUFER S,NAVARRO-MARTINEZ J,et al.Non-intubated video-assisted thoracic surgery management of secondary spontaneous pneumothorax[J].Ann Transl Med,2015,3(8):104.
[2] HUANG Y,HUANG H,LI Q,et al.Approach of the treatment for pneumothorax[J].J Thorac Dis,2014,6(Suppl 4):S416-420.
[3] SU H L,KIM N,CHANG Y L,et al.Effects of dexmedetomidine on oxygenation and lung mechanics in patients with moderate chronic obstructive pulmonary disease undergoing lung cancer surgery:A randomised double-blinded trial[J].Eur J Anaesthesiol,2016,33(4):275-282.
[4] REDWAN B,BIANCOSINO C,GIEBEL F,et al.Perioperative single-site veno-venous extracorporeal CO2 removal for minimally invasive giant bulla resection[J].Perfusion,2017,32(8):698-701.
[5] DAMERA G,PHAM T H,ZHANG J,et al.A Sputum Proteomic Signature That Associates with Increased IL-1β Levels and Bacterial Exacerbations of COPD[J].Lung,2016,194(3):363-369.
[6] 孙健,郭荣,张群.CT引导下序贯减容术治疗肺大疱对患者血气分析及肺功能指标的影响[J].现代医学,2015,43(10):1291-1293.
[7] SMID D E,WILKE S,JONES P W,et al.Impact of cardiovascular comorbidities on COPD Assessment Test (CAT) and its responsiveness to pulmonary rehabilitation in patients with moderate to very severe COPD:protocol of the Chance study[J].Bmj Open,2015,5(7):439-461.
[8] 潘立萍,苏冬菊,鲍永霞,等.IL-17、IL-10及HBP变化与AECOPD感染程度关系的研究进展[J].东南大学学报(医学版),2017,36(2):272-275.
[9] ADEWOLE O O,DE K T,PHILLIPS A S,et al.Effectiveness of thoracoscopic talc pleurodesis in the management of complicated spontaneous pneumothorax[J].J Bronchology Interv Pulmonol,2015,22(1):48-51.
[10] WRIGHT A,NEWBY C,HARTLEY R,et al.Myeloid-derived suppressor cell-like fibrocytes are increased and associated with preserved lung function in chronic obstructive pulmonary disease[J].Allergy,2017,72(4):645-655.
[11] CÓRDOBA-LANÚS E,BAZ-DÁVILA R,ESPINOZA-JIMÉNEZ A,et al.IL-8 gene variants are associated with lung function decline and multidimensional BODE index in COPD patients but not with disease susceptibility:a validation study[J].COPD,2015,12(1):55-61.
[12] UP H,YEONG-DAE K,SU C J,et al.The Effect of Thoracoscopic Pleurodesis in Primary Spontaneous Pneumothorax:Apical Parietal Pleurectomy versus Pleural Abrasion[J].Korean J Thorac Cardiovasc Surg,2012,45(5):316-319.
[13] MIN X,HUANG Y,YANG Y,et al.Mechanical pleurodesis does not reduce recurrence of spontaneous pneumothorax:a randomized trial[J].Ann Thorac Surg,2014,98(5):1790-1796.

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