The Relationship between Intraoperative Spirometry and Prognosis of Lung Volume Reduction Surgery in Patients with Severe Emphysema / 대한마취과학회지

BACKGROUND: Lung volume reduction surgery (LVRS) for severe emphysema can significantly improve maximal expiratory flow rates and ameliorate dyspnea on exertion, probably by reducing airway resistance and by reducing hyperinflation with corresponding improvement in inspiratory muscle function. We have recently experienced 12 cases of bilateral LVRS in patients with severe emphysema in an effort to improve pulmonary function. Among these patients we examined the relationship between intraoperative spirometry and prognosis of LVRS. METHODS: Intraoperative total dynamic lung compliance (CT) and % of breath exhaled in one second (V1.0%) obtained immediately pre-lung reduction was compared with immediate post-lung reduction. In addition we also compared a preoperative pulmonary function test (PFT) [FEV1, TLC, and FRC] with 3 month postoperative values. RESULTS: Six of the twelve patients demonstrated post-reduction improvement in dynamic CT and V1.0% during LVRS. These six patients demonstrated an increase in FEV1 and a decrease in TLC, and FRC 3 months after an LVRS. The other six patients without improvement in V1.0% during an LVRS had no change in the PFT three months after an LVRS. CONCLUSIONS: It appears that sidestream spirometry with immediate intraoperative measurement of dynamic CT and V1.0% could play a role in predicting the expected follow-up objective PFT; improvement in both CT and V1.0% may predict significant increases in PFT.

Primary experience of 13 cases of lung volume reduction surgery using domestic staplers and autologous tissue / 中国微创外科杂志

Objective To evaluate the results of lung volume reduction surgery (LVRS) using domestic staplers and autologous tissue. Methods Thirteen male patients received LVRS from June 2000 to March 2006 in this hospital. The age range was 56~68 years (mean, 60.5 years). The patients had a history of chronic obstructive pulmonary disease (COPD) for 2~16 years (mean, 11 years). The operation was performed under general anesthesia, with single lung ventilation. A muscle sparing thoracotomy in the 5th intercostal space was conducted. The “target area” was identified by combination of observation and palpation during operation and preoperative CT scans. The cutting edge was stapled with domestic staplers buttressed with autologous tissue. Results All the procedures were successfully accomplished. Follow-up observations for 8 months ~ 5 years showed no dyspnea and improved activities. At 6 months after operation, the FEV_1 and the PaO_2 were increased by 94.4%?21.2% and 12.5%?3.1%, while the RV and TLC were decreased by 24.1%?7.8% and 20.8%?5.1%, respectively. All the abovementioned parameters were significantly changed before and after operation (P