肺嚢胞症に対する手術術式と術後呼吸管理法に関する臨床的研究

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  • STUDIES ON THE SURGICAL PROCEDURE AND POSTOPERATIVE RESPIRATORY MANAGEMENT FOR BULLOUS EMPHYSEMA

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In 31 patients with bullous emphysema who underwent surgical treatment, the morphology of bullae and remaining lungs were classified retrospectively in terms of the surgical findings and techniques in order to compare the kinds and characteristics of postoperative complications. Intrathoracic electrophrenic respiration under negative pressure was used in 14 patients after pulmonary surgery, and considerations were made as to whether this method was adequate for postoperative respiratory management patients with bullous emphysema. The results were as follows.<br> 1) When there were no emphysematous changes in the remaining lungs and the bullae formed congregations of multiple small bullae or were large or giant bullae having constricted portions (15 cases), no problems arose in either the performance of surgery or the postoperative course.<br> 2) Surgical treatment was difficult in patients who had severe emphysematous changes in the remaining lungs with congregations of multiple small bullae and who did not respond to conservative treatment (five cases). In these patients, the currently most adequate surgical method seemed to be the one by which the affected lung was fully collapsed by means of double-tube endotracheal intubation and subjected to a minimum of reduction suture in combination with the application of fibrin paste at that site.<br> 3) When the bullae had no constricted portions and were large or giant (11 cases), regardless of the morphology of the remaining lungs, various postoperative complications in the lung on the operation side and/or on the opposite side occurred in about half of the patients. As to causes, lobectomy, the Naclerio-Langer method for cystectomy, and postoperative transitory positive pressure respiration were cited. To decrease these complications, cystectomy plus reduction suture of the lung was devised, and the method of negative pressure respiration was investigated.<br> 4) As negative pressure respiration, transitory electric stimulation of the intrathoracic phrenic nerve was used in 14 patients after pulmonary surgery. The results were almost completely satisfactory in both ventilation and circulation. In particular, this method exerted a right cardiac assisting effect. It was suggested that our method is simple and useful for postoperative temporary respiration assistance in patients with bullous emphysema who have undergone surgery and in whom change in the capacity of lung on the side opposite to that receiving surgery is predicted.

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