PDF(Pubmed)
Abstract：
UNASSIGNED: To explore the efficacy and safety of medical thoracoscopic bulla volume reduction for the treatment of chronic obstructive pulmonary disease (COPD) combined with giant emphysematous bullae (GEB).
UNASSIGNED: A total of 66 patients with COPD combined with GEB were enrolled in the study. All the subjects received treatment at Zhengzhou Central Hospital affiliated with Zhengzhou University between March 2021 and December 2022. The subjects were divided into two groups, a medical thoracoscope group consisting of 30 cases treated with medical thoracoscopic bulla volume reduction and a surgical thoracoscope group consisting of 36 cases treated by video-assisted thoracoscopic surgery. All patients were followed up before discharge and 3 months and 6 months after discharge. The preoperative and postoperative levels of the pulmonary function, 6-minute walk distance (6MWD), and St. George\'s Respiratory Questionnaire (SGRQ) scores and differences in postoperative complications were compared between the two groups. The operative duration, postoperative length-of-stay, and surgical costs and hospitalization bills, and the maximum visual analog scale (VAS) pain scores at 24 h after the procedure were assessed.
UNASSIGNED: The baseline data of the two groups were comparable, showing no statistically significant difference. The forced expiratory volume in 1 second (FEV1) 6 months after the procedures improved in both the medical thoracoscopy group ([0.78±0.29] L vs. [1.02±0.31] L, P<0.001) and the surgical thoracoscopy group ([0.80±0.21] L vs. [1.03±0.23] L, P<0.001) compared to that before the procedures. Improvements to a certain degree in 6MWT and SGRQ scores were also observed in the two groups at 3 months and 6 months after the procedures (P<0.05). In addition, no statistically significant difference in these indexes was observed during the follow-up period of the patients in the two groups. There was no significant difference in operating time between the two groups. The medical thoracoscopy group had shorter postoperative length-of-stay ([7.3±2.6] d) and 24-hour postoperative VAS pain scores (3.0 [2.0, 3.3]) than the surgical thoracoscopic group did ([10.4±4.3] d and 4.5 [3.0, 5.0], respectively), with the differences being statistically significant (P<0.05). Surgical cost and total hospitalization bills were lower in the medical thoracoscopy group than those in the surgical thoracoscopy group (P<0.05). The complication rate in the medical thoracoscopy group was lower than that in the surgical thoracoscopy group (46.7% vs. 52.8%), but the difference was not statistically significant.
UNASSIGNED: Medical thoracoscopic reduction of bulla volume can significantly improve the pulmonary function, quality of life, and exercise tolerance of patients with COPD combined with GEB, and it can reduce postoperative short-term pain and shorten postoperative length-of-stay. The procedure has the advantages of minimal invasiveness, quick recovery, and low costs. Hence extensive clinical application is warranted.
UNASSIGNED: A total of 66 patients with COPD combined with GEB were enrolled in the study. All the subjects received treatment at Zhengzhou Central Hospital affiliated with Zhengzhou University between March 2021 and December 2022. The subjects were divided into two groups, a medical thoracoscope group consisting of 30 cases treated with medical thoracoscopic bulla volume reduction and a surgical thoracoscope group consisting of 36 cases treated by video-assisted thoracoscopic surgery. All patients were followed up before discharge and 3 months and 6 months after discharge. The preoperative and postoperative levels of the pulmonary function, 6-minute walk distance (6MWD), and St. George\'s Respiratory Questionnaire (SGRQ) scores and differences in postoperative complications were compared between the two groups. The operative duration, postoperative length-of-stay, and surgical costs and hospitalization bills, and the maximum visual analog scale (VAS) pain scores at 24 h after the procedure were assessed.
UNASSIGNED: The baseline data of the two groups were comparable, showing no statistically significant difference. The forced expiratory volume in 1 second (FEV1) 6 months after the procedures improved in both the medical thoracoscopy group ([0.78±0.29] L vs. [1.02±0.31] L, P<0.001) and the surgical thoracoscopy group ([0.80±0.21] L vs. [1.03±0.23] L, P<0.001) compared to that before the procedures. Improvements to a certain degree in 6MWT and SGRQ scores were also observed in the two groups at 3 months and 6 months after the procedures (P<0.05). In addition, no statistically significant difference in these indexes was observed during the follow-up period of the patients in the two groups. There was no significant difference in operating time between the two groups. The medical thoracoscopy group had shorter postoperative length-of-stay ([7.3±2.6] d) and 24-hour postoperative VAS pain scores (3.0 [2.0, 3.3]) than the surgical thoracoscopic group did ([10.4±4.3] d and 4.5 [3.0, 5.0], respectively), with the differences being statistically significant (P<0.05). Surgical cost and total hospitalization bills were lower in the medical thoracoscopy group than those in the surgical thoracoscopy group (P<0.05). The complication rate in the medical thoracoscopy group was lower than that in the surgical thoracoscopy group (46.7% vs. 52.8%), but the difference was not statistically significant.
UNASSIGNED: Medical thoracoscopic reduction of bulla volume can significantly improve the pulmonary function, quality of life, and exercise tolerance of patients with COPD combined with GEB, and it can reduce postoperative short-term pain and shorten postoperative length-of-stay. The procedure has the advantages of minimal invasiveness, quick recovery, and low costs. Hence extensive clinical application is warranted.
摘要：
■探讨内科胸腔镜下肺大泡减容术治疗慢性阻塞性肺疾病(COPD)合并巨大气肿性肺大泡(GEB)的疗效和安全性。
■共纳入66例COPD合并GEB患者。所有受试者于2021年3月至2022年12月在郑州大学附属郑州中心医院接受治疗。受试者分为两组，内科胸腔镜组30例采用内科胸腔镜肺大泡减容术治疗，外科胸腔镜组36例采用电视胸腔镜手术治疗。所有患者均于出院前及出院后3个月、6个月进行随访。术前、术后肺功能水平,6分钟步行距离（6MWD），比较两组患者术后并发症及圣乔治呼吸问卷(SGRQ)评分差异。手术持续时间,术后住院时间,手术费用和住院账单，并评估术后24h的最大视觉模拟量表（VAS）疼痛评分。
■两组基线资料具有可比性,差异无统计学意义。两个内科胸腔镜组术后1秒用力呼气量（FEV1）6个月均有所改善（[0.78±0.29]Lvs.[1.02±0.31]L,P<0.001）和手术胸腔镜组（[0.80±0.21]Lvs.[1.03±0.23]L,P<0.001）与手术前相比。两组术后3个月和6个月6MWT和SGRQ评分均有一定程度的改善(P<0.05)。此外,两组患者随访期间,上述指标差异无统计学意义.两组手术时间差异无统计学意义。内科胸腔镜组术后住院时间([7.3±2.6]d)和术后24小时VAS疼痛评分(3.0[2.0,3.3])短于外科胸腔镜组([10.4±4.3]d和4.5[3.0,5.0],分别)，差异有统计学意义(P<0.05)。内科胸腔镜组手术费用和住院总费用均低于外科胸腔镜组(P<0.05)。内科胸腔镜组并发症发生率低于外科胸腔镜组(46.7%vs.52.8%），但差异无统计学意义。
■医用胸腔镜缩小大疱体积可明显改善肺功能，生活质量,COPD合并GEB患者的运动耐量，可以减轻术后短期疼痛，缩短术后住院时间。该程序具有最小侵入性的优点，快速恢复,和低成本。因此，广泛的临床应用是必要的。
■共纳入66例COPD合并GEB患者。所有受试者于2021年3月至2022年12月在郑州大学附属郑州中心医院接受治疗。受试者分为两组，内科胸腔镜组30例采用内科胸腔镜肺大泡减容术治疗，外科胸腔镜组36例采用电视胸腔镜手术治疗。所有患者均于出院前及出院后3个月、6个月进行随访。术前、术后肺功能水平,6分钟步行距离（6MWD），比较两组患者术后并发症及圣乔治呼吸问卷(SGRQ)评分差异。手术持续时间,术后住院时间,手术费用和住院账单，并评估术后24h的最大视觉模拟量表（VAS）疼痛评分。
■两组基线资料具有可比性,差异无统计学意义。两个内科胸腔镜组术后1秒用力呼气量（FEV1）6个月均有所改善（[0.78±0.29]Lvs.[1.02±0.31]L,P<0.001）和手术胸腔镜组（[0.80±0.21]Lvs.[1.03±0.23]L,P<0.001）与手术前相比。两组术后3个月和6个月6MWT和SGRQ评分均有一定程度的改善(P<0.05)。此外,两组患者随访期间,上述指标差异无统计学意义.两组手术时间差异无统计学意义。内科胸腔镜组术后住院时间([7.3±2.6]d)和术后24小时VAS疼痛评分(3.0[2.0,3.3])短于外科胸腔镜组([10.4±4.3]d和4.5[3.0,5.0],分别)，差异有统计学意义(P<0.05)。内科胸腔镜组手术费用和住院总费用均低于外科胸腔镜组(P<0.05)。内科胸腔镜组并发症发生率低于外科胸腔镜组(46.7%vs.52.8%），但差异无统计学意义。
■医用胸腔镜缩小大疱体积可明显改善肺功能，生活质量,COPD合并GEB患者的运动耐量，可以减轻术后短期疼痛，缩短术后住院时间。该程序具有最小侵入性的优点，快速恢复,和低成本。因此，广泛的临床应用是必要的。
