Bullectomy Through Minimally Invasive Approach For 103 Patients With Bullous Emphysema

Objective To explore the clinical effects of mini-invasive treatment in patients with bullous emphysema.Methods One hundred and three patients with bullous emphysema, who underwent bullectomy through mini-invasive approach by the same group were enrolled in this study. The approach included video–assisted thoracic surgery(VATS) and video–assisted mini-thoracotomy(VAMT).The related parameters including basic information of patients, intraoperative as well as postoperative were analyzed retrospectively. Results One hundred patients were cured(97.08%), 3 patients(2.92%) discharged with closed chest drainage, and all of the chest drainage were removed in 1-2 months after discharged. Five(4.85%), 17(16.5%) and 12(11.6%) patients suffered from postoperative persistent air leaking(over 14 days), pulmonary infection and arrhythmia, respectively. Two patients underwent re-operation due to persistent air leaking(1.94%) and there were no death case during the perioperative period. Compare with preoperative value,the postoperative MRC grades(Medical Research Council Scale) were significantly decreased(3.79±0.69 vs 3.12±0.67, P<0.001),meanwhile PaO2 in postoperative period significantly increased(87.44±18.94 mmHg vs 75+.30±19.01 mmHg, P<0.001). Patients with smoking index greater than 600 cigarettes per year had significant relationship with greater ratio of multiple pulmonary bullous, the type of bullous, the concurrence of COPD and MRC grade(P < 0.05). Interestingly, compared the effects between two different minimal approach of operations(VATS and VAMT), there were significant difference in the operative time, volumes of intraoperative bleeding, rates of hemostatic drug usage, the duration and total volumes of postoperative intrathoracic drainage tube, while there were no significant difference regarding(MRC grades and PaO2)(P>0.05).Conclusion Bullectomy through miniinvasive approaches are safe and effective for patients with of bullous emphysema. Reasonable mini-invasive surgical approaches should be selected according to the preoperative examinations and operative exploration.