PDF(Pubmed)
Abstract：
UNASSIGNED: There is an assumption that because EBLVR requires less use of hospital resources, offsetting the higher cost of endobronchial valves, it should therefore be the treatment of choice wherever possible. We have tested this hypothesis in a retrospective analysis of the two in similar groups of patients.
UNASSIGNED: In a 4-year experience, we performed 177 consecutive LVR procedures: 83 patients underwent Robot Assisted Thoracoscopic (RATS) LVRS and 94 EBLVR. EBLVR was intentionally precluded by evidence of incomplete fissure integrity or intra-operative assessment of collateral ventilation. Unilateral RATS LVRS was performed in these cases together with those with unsuitable targets for EBLVR.
UNASSIGNED: EBLVR was uncomplicated in 37 (39%) cases; complicated by post-procedure spontaneous pneumothorax (SP) in 28(30%) and required revision in 29 (31%). In the LVRS group, 7 (8%) patients were readmitted with treatment-related complications, but no revisional procedure was needed. When compared with uncomplicated EBLVR, LVRS had a significantly longer operating time: 85 (14-82) vs 40 (15-151) minutes (p<0.001) and hospital stay: 7.5 (2-80) vs 2 (1-14) days (p<0.01). However, LVRS had a similar total operating time to both EBLVR requiring revision: 78 (38-292) minutes and hospital stay to EBLVR complicated by pneumothorax of 11.5 (6.5-24.25) days. Use of critical care was significantly longer in RATS group, and it was also significantly longer in EBV with SP group than in uncomplicated EBV group.
UNASSIGNED: Endobronchial LVR does use less hospital resources than RATS LVRS in comparable groups if the recovery is uncomplicated. However, this advantage is lost if one includes the resources needed for the treatment of complications and revisional procedures. Any decision to favour EBLVR over LVRS should not be based on the assumption of a smoother, faster perioperative course.
UNASSIGNED: In a 4-year experience, we performed 177 consecutive LVR procedures: 83 patients underwent Robot Assisted Thoracoscopic (RATS) LVRS and 94 EBLVR. EBLVR was intentionally precluded by evidence of incomplete fissure integrity or intra-operative assessment of collateral ventilation. Unilateral RATS LVRS was performed in these cases together with those with unsuitable targets for EBLVR.
UNASSIGNED: EBLVR was uncomplicated in 37 (39%) cases; complicated by post-procedure spontaneous pneumothorax (SP) in 28(30%) and required revision in 29 (31%). In the LVRS group, 7 (8%) patients were readmitted with treatment-related complications, but no revisional procedure was needed. When compared with uncomplicated EBLVR, LVRS had a significantly longer operating time: 85 (14-82) vs 40 (15-151) minutes (p<0.001) and hospital stay: 7.5 (2-80) vs 2 (1-14) days (p<0.01). However, LVRS had a similar total operating time to both EBLVR requiring revision: 78 (38-292) minutes and hospital stay to EBLVR complicated by pneumothorax of 11.5 (6.5-24.25) days. Use of critical care was significantly longer in RATS group, and it was also significantly longer in EBV with SP group than in uncomplicated EBV group.
UNASSIGNED: Endobronchial LVR does use less hospital resources than RATS LVRS in comparable groups if the recovery is uncomplicated. However, this advantage is lost if one includes the resources needed for the treatment of complications and revisional procedures. Any decision to favour EBLVR over LVRS should not be based on the assumption of a smoother, faster perioperative course.
摘要：
■有一个假设，因为EBLVR需要更少的医院资源使用，抵消了支气管内瓣膜的较高成本，因此，它应该是尽可能选择的治疗方法。我们在相似的患者组中对这两种情况进行了回顾性分析，检验了这一假设。
■有4年的工作经验,我们进行了177例连续的LVR手术:83例患者接受了机器人辅助胸腔镜(RATS)LVRS和94例EBLVR.通过不完全的裂隙完整性或间接通气的术中评估，有意排除了EBLVR。在这些情况下，与不适合EBLVR靶标的患者一起进行单侧RATSLVRS。
■EBLVR在37例（39％）病例中无并发症；28例（30％）并发术后自发性气胸（SP），29例（31％）需要修订。在LVRS组中，7例（8%）患者因治疗相关并发症再次入院，但不需要修订程序.与简单的EBLVR相比，LVRS的手术时间明显更长：85（14-82）vs40（15-151）分钟（p<0.001），住院时间：7.5（2-80）vs2（1-14）天（p<0.01）。然而,LVRS的总手术时间与需要修订的EBLVR相似：78（38-292）分钟，住院时间与EBLVR并发气胸11.5（6.5-24.25）天。在RATS组中，重症监护的使用时间明显更长，SP组EBV明显长于单纯EBV组。
■如果恢复不复杂，则在可比组中，支气管内LVR确实比RATSLVRS使用更少的医院资源。然而,如果包括治疗并发症和修订程序所需的资源,这一优势就会丧失.任何赞成EBLVR而不是LVRS的决定都不应基于更平滑的假设，围手术期更快。
■有4年的工作经验,我们进行了177例连续的LVR手术:83例患者接受了机器人辅助胸腔镜(RATS)LVRS和94例EBLVR.通过不完全的裂隙完整性或间接通气的术中评估，有意排除了EBLVR。在这些情况下，与不适合EBLVR靶标的患者一起进行单侧RATSLVRS。
■EBLVR在37例（39％）病例中无并发症；28例（30％）并发术后自发性气胸（SP），29例（31％）需要修订。在LVRS组中，7例（8%）患者因治疗相关并发症再次入院，但不需要修订程序.与简单的EBLVR相比，LVRS的手术时间明显更长：85（14-82）vs40（15-151）分钟（p<0.001），住院时间：7.5（2-80）vs2（1-14）天（p<0.01）。然而,LVRS的总手术时间与需要修订的EBLVR相似：78（38-292）分钟，住院时间与EBLVR并发气胸11.5（6.5-24.25）天。在RATS组中，重症监护的使用时间明显更长，SP组EBV明显长于单纯EBV组。
■如果恢复不复杂，则在可比组中，支气管内LVR确实比RATSLVRS使用更少的医院资源。然而,如果包括治疗并发症和修订程序所需的资源,这一优势就会丧失.任何赞成EBLVR而不是LVRS的决定都不应基于更平滑的假设，围手术期更快。
