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背景:肺、食管贲门疾病尤其是恶性肿瘤病例,常常需外科治疗,但合并重度肺气肿的患者由于肺功能较差常常失去手术机会。肺减容术(lungvolumereductionsurgery,LVRS)是治疗重度肺气肿的有效方法。目前尚缺乏有关将两种手术方式结合以增加上述病例外科治疗机会的系统研究。目的:评价肺、食管贲门疾病外科治疗的同时行同侧LVRS后患者的肺功能变化及其对患者运动能力的影响。设计:采用自身手术前后对照的临床研究方法。地点和对象:资料收集于第三军医大学大坪医院胸外科中心。对26例重度肺气肿合并肺、食管贲门疾病患者进行手术和肺功能检测。干预措施:11例重度肺气肿合并食管贲门癌患者行食管贲门癌切除、食管胃胸腔内吻合的同时,将小牛心包片缝垫于美国强生公司产TLC75直线形切割缝合器的两个钉合面,根据术前影像学检查及术中所见并结合胸腔胃的大小,切除边缘部过度气肿的肺组织,切除部分大约为单侧肺容积的25%～30%;9例肺气肿合并肺癌者施行肺叶切除术;6例肺气肿合并肺部其他良性疾病者施行包括病变在内的肺楔形切除术。若有漏气,则喷注医用生物蛋白胶。比较术前、术后的肺功能。主要观察指标:手术前后下列指标的变化情况:呼吸困难指数、第一秒用力呼气容积(forcedexpiratoryvolumewithin1second,FEV1)、F
Background: Pulmonary, esophageal and cardial diseases, especially malignant cases, are often treated surgically, but patients with severe emphysema often lose the chance of surgery due to poor lung function. Lung volume reduction therapy (LVRS) is an effective method for the treatment of severe emphysema. There is currently no systematic study on the combination of the two surgical modalities to increase the chance of surgical treatment in these cases. OBJECTIVE: To evaluate the changes of pulmonary function in patients undergoing ipsilateral LVRS with surgical treatment of pulmonary and esophageal and cardial diseases and their effects on motor function. Design: A clinical study using self-control before and after surgery. Location and Subjects: Data were collected at the Department of Thoracic Surgery, Daping Hospital, Third Military Medical University. Twenty-six patients with severe emphysema complicated with pulmonary and esophageal cardia diseases underwent surgery and pulmonary function tests. Interventions: 11 cases of severe emphysema with esophageal and cardiac cancer patients underwent resection of esophageal and cardia cancer, esophagogastric anastomosis at the same time, the calf pericardium was stitched in the United States Johnson & Johnson produced TLC75 linear stapler suture two staples Meet the surface, according to preoperative imaging and intraoperative findings and combined with the size of the thoracic cavity, removal of the edge of the emphysematous lung tissue resection of the unilateral lung volume is about 25% to 30%; 9 cases of lung gas Pulmonary lobectomy was performed in patients with swollen lung cancer; 6 patients with emphysema and other benign pulmonary diseases underwent wedge resection including lesions. If leaky, then spray medical bioprotein glue. Compare preoperative and postoperative lung function. MAIN OUTCOME MEASURES: Changes of the following indexes before and after surgery: index of dyspnea, forcedexpiratoryvolumewithinsecondary second (FEV1), F