The Clinical Study For LVRS By VATS And Traditional Thoracotomy In Patients With Severe Emphysema

Objective To explore the treatment effect of lung volume reduction surgery (LVRS) for patients with severe emphysema and summarize the difference of the treatment by comparing the treating effect between thoracoscopy and thoracotomy.Methods32patients with severe emphysema who accepted LVRS in the second affiliated hospital of kunming medical university between October of2009and September of2013were retrospectively analyzed. They were divided into traditional thoracotomy group (18cases) and the thoracoscope group (14cases) according to the different operation method.Well preparation and lung protection should be taken before the operation. The Peripheral20-30%of the lung tissue were cut by Linear cutting anastomat with absorbability polyglycolic acid(APA) repair material (NEOVEIL). Support treatments such as assistant breath by breathing machine, phlegm, anti-infection, symptomatic were taken after the operation. To evaluat the surgical effects by analyzing the variation of FEVi (forced expiratory volume in the first seconds), TLC (Total Lung Capacity),RV (Residual Volume),PaO2(arterial blood oxygen partial pressure), PaCO2(arterial blood CO2partial pressure),6-MWD (six minute walking distance) before the operation and3months after leaving the hospital. Analysis the advantages and disadvantages of different surgical methods by comparing the operation time, blood loss, hospital stay, postoperative complications and the chest tube drainage time of thoracotomy group with the thoracoscope group.Results There was no death, transfer thoracotomy and tracheotomy. The FEV1,PaO2and6-MWD measured3months after leaving the hospital is higher than them before the operation, at the same time, the TLC, RV and PaCO2decrease (P<0.01). The indicators between the two groups did not differ between the change (P>0.05). Compared with thoracoscope group, the figure of hospitalization time, blood loss, chest tube time, postoperative chest tube flow, time of postoperative analgesia on the first day in thoracotomy group were higher (P<0.01); But the incidence of postoperative complications such as postoperative continuous leakage, pulmonary infection, infection of incision had no difference in two groups (P>0.05).Conclusion LVRS is an effective method for the treatment of emphysema because it can improve the pulmonary function, blood gas analysis index and quality of life in patients with severe emphysema. Compared with the thoracotomy surgery, thoracoscope surgery effect is exact. It can be used in patients with poor lung function for its small trauma. However, the differences of the postoperative complications still need further studies.