应用国产缝合器行单侧肺减容术治疗极重度COPD的疗效分析

目的评价应用国产重复性缝合器行单侧肺减容术（LVRS）治疗极重度慢性阻塞性肺疾病（COPD）的疗效、手术适应证，总结手术操作要点。方法选取2002年6月至2008年11月间住院的极重度COPD患者30例，行单侧肺减容术治疗。应用国产重复性缝合器切除过度充气破坏的肺组织。比较手术前后的呼吸困难程度、肺功能及生活质量等指标的变化，以评价单侧LVRS的手术疗效。结果第1秒钟用力呼气容积（FEV1）在术后6个月较术前提高45．7％；呼吸困难指数普遍改善Ⅰ-Ⅱ级。6min步行距离（6MWD）对比，术后6个月（310±75）m平均较术前（202±89）m增加53．5％。术后6个月Kamofsky评分（79±8．3）分较术前（25±4．5）分明显提高。本组病人术后6个月生存率为100％，无手术死亡病例。术后并发症发生率为43．3％。结论对符合指征的极重度COPD患者，行单侧肺减容术治疗可明显改善患者术后肺功能和生活质量，手术病死率低。国产重复性缝合器具有操作简单、质量可靠、安全实用等优点，可应用于单侧肺减容术，能明显降低医疗费用。

Clinical study on the effectiveness of unilateral lung volume reduction surgery in patients with chronic obstructive pulmonary disease using domestic-made stapler

Objective To evaluate the effectiveness of unilateral lung volume reduction surgery（LVRS） in patients with chronic obstructive pulmonary disease （ COPD ） using domestic - made stapler. Methods Thirty patients received unilateral lung volume reduction surgery from June 2002 to November 2008 in Hospital. Destroyed pulmonary tissue was resected by domestic - made stapler. To evaluate the effectiveness of unilateral LVRS, the changing of dyspnea score, pulmonary function and the quality of life were analyzed. Results The postoperative follow - up interval range was 6 months. The mean postoperative FEVI increased by 45.7%, and six minute walking distance（6MWD） increased by 53.5%. （P 〈 0. 01 ）For dyspnea seore,I -II grade were improved for all patients. Karnofsky score improved from （ 25 ± 4. 5 ） to （ 79 ± 8. 3 ）. （ P 〈 0.01 ）. Six months survival rates was 100%. There was no perioperative death in this group,and the total postoperative morbidity was 43.3%. Conclusions Unilateral LVRS shows significant clinical benefits for the matching patients with COPD. It is associated with lower operative mortality and morbidity. Domestic - made repetitive stapler can be applied to unilateral lung volume reduction surgery with simple, reliable, safe and practical advantages. It can obviously decrease medical care expens.