Effects of homochronous lung volume reduction surgery on pulmonary functions and exercise capability of patients with pulmonary or esophageal malignant tumor

doi:10.3321/j.issn:1673-8225.2004.11.013

Abstract：BACKGROUND: Surgical procedures are often necessary in removing the lesions in esophageal or pulmonary diseases, particularly malignant tumors. Unfortunately, because of poor pulmonary function, some patients combined with severe emphysema often lose the opportunities to receive surgical treatment. Lung volume reduction surgery(LVRS) is an effective operation for severe emphysema. However, little systemic research has been conducted on the combination of the two surgical procedures to increase opportunities of surgical treatment.OBJECTIVE: To evaluate the effects of homochronous LVRS on pulmonary function and exercise capacity of the patients after receiving pulmonary or esophageal resection.DESIGN: Pre-and post-operative self-consistency validation was performed in 26 patients of esophageal or pulmonary diseases combined with severe emphysema.SETTING and PARTICIPANTS: Twenty-six patients with esophageal or pulmonary diseases combined with severe emphysema received surgical treatment. All the operations were carried out in Department of Thoracic Surgery, Daping Hospital of Third Military Medical University.INTERVENTIONS: Eleven patients underwent esophageal or cardiac carcinoma resection and gastroesophageostomy. Then, unilateral LVRS was performed using the EZ75 stapling gun. All staple lines were buttressed with bovine pericardial strips. The removed pulmonary tissues damaged by emphysema made up about 25%-30% of the unilateral lung parenchyma. The resection was performed on the basis of preoperative imnging examinations,what was seen at surgery and the volume of the part of stomach in thorax.Lobectomy and wedge resection involving the lesions were completed in 9 patients with lung cancer and 6 patients with benign diseases, respectively.Then, fibrin sealant was insuffiated in case of air leakage. The pre-and post-operative pulmonary functions were compared.MAIN OUTCOME MEASURES: Pre-and post-operative changes of the following iudexes: dyspuea index, forced expiratory volume within 1 second (FEV1), forced vital capacity(FEV1/FVC), diffusing capacity of lung for carbon monoxide(DLCO), residual volume(RV), PaO2, PaCO2 and six-minute walk distance (6MWD).RESULTS: All the patients went through perioperative stage safely and dyspnea in patients was partially improved from degree Ⅲ to Ⅱ. FEV1,FEV1/FVC, DLCO, RV, PaO2, PaCO2 and 6MWD were all better than the preoperative ones.CONCLUSION: For some patients with severe emphysema combined with other thoracic diseases, homochrnnous LVRS might uot ouly improve the pulmonary function, but also create the oppertunity of surgical treatment,and improve exercise capacity and quality of life.