Efficacy of thoracoscopic pulmonary bulla resection in treating giant emphysematous bulla complicated with moderate to severe pulmonary hypofunction

Objective To observe the clinical effects of single- and double-port thoracoscopic pulmonary bulla (PB) resection in the treatment of giant emphysematous bulla (GEB) patients with moderate to severe pulmonary hypofunction.

Methods A total of 92 GEB patients with moderate to severe pulmonary hypofunction were randomly divided into study group with 46 cases (treated with single-port thoracoscopic PB resection) and control group with 46 cases (treated with double-port thoracoscopic PB resection). Surgical condition, postoperative recovery, pulmonary function indexes forced expiratory volume in the first second as a percentage (FEV₁%), maximal ventilatory volume as a percentage (MVV%), arterial blood gas indexes arterial partial pressure of oxygen p_a(O₂), arterial partial pressure of carbon dioxide p_a(CO₂), serum inflammatory factors C-reactive protein (CRP), interleukin-6 (IL-6), transforming growth factor β receptor 1 (TβR1), fibroblast growth factor-10 (FGF-10), 6 minutes walking distance (6 MWD), St. George′s Respiratory Questionnaire (SGRQ) score, incidence of complications and recurrence rate were compared between two groups.

Results The bleeding volume and thoracic drainage volume in the study group were significantly less than those in the control group, and the postoperative catheterization time and hospital stay were significantly shorter than those in the control group (P < 0.05); the serum levels of CRP, IL-6, TβR1 and FGF-10 in the study group were significantly lower than those in the control group at 1 week after operation (P < 0.05); the FEV₁%, MVV% and p_a(O₂) in both groups at 6 months after operation were significantly higher than those before operation, while p_a(CO₂) was significantly lower than that before operation (P < 0.05); the 6 MWD and SGRQ score at 6 months after operation in both groups were significantly higher than those before operation (P < 0.05); the incidence of complications in the study group was 8.70%, which was significantly lower than 23.91% in the control group (P < 0.05); there was no case with recurrence of PB in both groups after re-examination of chest CT on the operation side within 12 months after operation.

Conclusion For GEB patients with moderate to severe pulmonary hypofunction, thoracoscopic PB resection can significantly improve patient's lung function and quality of life. Single-port thoracoscopic surgery can further alleviate surgical trauma, and reduce the incidence of complications and promote postoperative recovery.