Perioperative management of video-assisted thoracoscopic lung volume reduction / 中国微创外科杂志

ABSTRACT

Objective To summarize the experience of perioperative management of lung volume reduction surgery(LVRS) under video-assisted thoracoscopy.Methods A total of 40 patients with severe chronic obstructive pulmonary disease(COPD) underwent LVRS under video-assisted thoracoscopy.A mini-incision thoracotomy was given in 23 of them.During the operation,the Endo-GIA was utilized to resect 20%~30% of total volume of affected lung.Results The LVRS was performed in bilateral lungs in 13 patients(under thoracoscopy only in 7 patients and with the assistance of mini-incision thoracotomy in 6 patients) and in unilateral lung in 27 patients(under thoracoscopy only in 10 patients and with the assistance of mini-incision thoracotomy in 17 patients).There were no surgery-related deaths.All the patients were discharged from the hospital 9~41 days(mean,18 days) after operation.Not only symptoms of dyspnea were obviously relieved but also the respiratory index was upgraded by 1~2 grades.The comparisons on pulmonary functions between preoperative time and 1 month after operation indicated a great improvement postoperatively,including the forced expiratory volume in 1 second(FEV_1)(48.3%?4.9% vs 68.5%?5.6% predicted;t=17.169,P=0.000),the residual volume(RV)(270.0%?23.6% vs 188.0%?19.8% predicted;t=16.835,P=0.000),and the total lung capacity(TLC)((123.0%?9.8%) vs 102.0%?8.7% predicted;t=10.135,P=0.000).Postoperative complications included air leakage in 10 patients,lung infection in 5 patients,and bronchial asthma in 3 patients,all of whom were cured after symptomatic management.A follow-up was conducted in 37 patients for 3~77 months(mean,46 months).Three patients died of lung cancer at 6,10, and 20 postoperative months,respectively.Two patients died of esophageal cancer at 3 and 8 postoperative months,respectively.And one patient died of cerebrovascular disease at 6 postoperative months.The remaining 31 patients survived. Conclusions Proper perioperative management is of great importance for a successful surgery and a rapid postoperative recovery.