o:38542 ,,Analiza uticaja patoanatomskog supstrata i funkcionalnog statusa bolesnika u odnosu na vrstu operacije i rezultate hirurškog lečenja emfizema pluća’’ doktorska disertacija ,,Analysis of the influence of pathoanatomic substrate and functional status of the patient in relation to the type of operation and the results of the surgical treatment of lung emphysema’’ : doctoral dissertation sr Medikamentozna terapija je oslonac u lečenju emfizema pluća a hirurško lečenje jedna od metoda izbora. Hirurške procedure koje imaju za cilj poboljšanje plućne funkcije i kvaliteta života kod odabranih bolesnika sa emfizemom pluća su: bulektomija, hirurška redukcija plućnog volumena (LVRS) i transplantacija pluća.Koncept LVRS-a je uspostavljen tokom prvih godina primene uz definisane kriterijume za sprovođenje ove procedure. Funkcionalno poboljšanje obično dostiže svoj maksimum oko 6 meseci nakon operacije. LVRS može da predstavlja funkcionalni most ka transplantaciji pluća koja se može primeniti kod ograničenog broja pacijenata..Primarni ciljevi našeg istraživanja bili su da se utvrdi procenat ispitanika kod kojih je ostvaren pozitivan ishod operacije i uticaj sledećih parametara na ishod operacije: pol, godine života, pušačke navike, pridružena oboljenja, FEV1, BMI, sat O2, 6-minutni test hoda, "MMRC" upitnik. Urađena je retrospektivno-prospektivna studija, koja je uključila 58 pacijenata sa emfizemom pluća, koji su u toku desetogodišnjeg perioda operisani u Klinici za grudnu hirurgiju, Univerzitetskog Kliničkog Centra Srbije u Beogradu i praćeni u dvogodišnjem postoperativnom periodu..Dobijeni rezultati pokazali su da je svih 58 pacijenta (100%) ostvarilo pozitivan ishod operacije. Kod 19 pacijenata učinjena je bulektomija, jednostrana LVRS kod 31, a sekvencijalna obostrana LVRS kod 8 pacijenata - srednji intervаl od 8 meseci. Preovlađivao je muški pol (72.4%), prosečna starosna dob pacijenata u grupi bulektomije - 47 godina a u grupama sa LVRS (56 i 53 godina). Od 58 analiziranih osoba, skoro svi su bili aktivni ili bivši pušači. Prosečan BMI iznosio je 23,6, terapiju steroidima (69%), komorbiditete (51,7%) ispitanika. Postoperativne komplikacije: reoperacija zbog krvarenja (3,4%), srčana aritmija (51,6%), pneumonija (8,6%), atelektaza (10,3%), empijem (1,7%), subkutani emfizem (22.4%), ,,air lekage’’＞7 dana (60%), dužina hospitalizacije (9-13 dana, min 5 max 30), mortalitet (0%). Uzgredni PH nalaz u 6,9% slučajeva a koegzistirаjući kаrcinom plućа (1,72%). Nakon 6 meseci od operacije došlo je do statistički značajnih poboljšanja u vrednostima FEV1, 6MWT, MMRC, BMI, kvaliteta života ali sa konstantnim padom u 12 i 24 mesecu.Prosečno povećanje FEV1 nakon 24 meseca od primene bulektomije, jednostrane i obostrane LVRS (210mL/230mL/550mL). Prosečni porast parametra 6MWT po grupama 24 mesecaod operacije (42,26m/48,61m/43,50m). Jednogodišnji pаd FEV1 je znаčаjаn u grupi bilаterаlne LVRS (240 ml/g), аli nije bio znаčаjаn u grupi bulektomije i jednostrаne LVRS (80 ml/g).Nakon operacije prosečni BMI ima trend porasta, postoji statistički značajan pad dispneje. Nakon operacije 89.5% do 100% pacijenata nije koristilo steroidnu terapiju a 63,2% - 75% pacijenata su se izjasnili, da im je kvalitet života bolji ili mnogo bolji.Rezultati preoperativno sprovedenih ispitivanja u korelaciji sa morfologijom emfizema, uz analizu patoanatomskog supstrata i primenjenom resekcijom, mogli bi da doprinesu identifikaciji bolesnika koji će uz prihvatljiv hirurški rizik, imati korist od hirurškog lečenja. Medical therapy is the mainstay in the treatment of lung emphysema, and surgical treatment is one of the methods of choice. Surgical procedures aimed at improving lung function and quality of life in selected patients with pulmonary emphysema is: bullectomy, lung volume reduction surgery (LVRS) and lung transplantation. The concept of LVRS was established during the first years of implementation with defined criteria for the implementation of this procedure. Functional improvement usually reaches its maximum about 6 months after surgery. LVRS can represent a functional bridge to lung transplantation that can be used in a limited number of patients. The primary goals of our research were to determine the percentage of respondents who had a positive outcome of the operation and the influence of the following parameters on the outcome of the operation: sex, age, smoking habits, associated diseases, FEV1, BMI, sat O2, 6-minute walk test, "MMRC" questionnaire. A retrospective-prospective study was conducted, which included 58 patients with emphysema of the lungs, who were operated on in the Clinic for Thoracic Surgery, University Clinical Center of Serbia in Belgrade, and followed up in the two-year postoperative period. The obtained results showed that all 58 patients (100%) achieved a positive outcome from the operation. Bullectomy was performed in 19 patients, unilateral LVRS in 31, and sequential bilateral LVRS in 8 patients - mean interval of 8 months. Male gender predominated (72.4%), the average age of patients in the bullectomy group was 47 years and in the LVRS groups (56 and 53 years). Of the 58 persons analyzed, almost all were active or ex-smokers. Average BMI was 23.6, steroid therapy (69%), comorbidities (51.7%) of respondents. Postoperative complications: reoperation due to bleeding (3.4%), cardiac arrhythmia (51.6%), pneumonia (8.6%), atelectasis (10.3%), empyema (1.7%), subcutaneous emphysema (22.4 %), "air leakage"＞7 days (60%), length of hospitalization (9-13 days, min 5 max 30), mortality (0%). Incidental PH finding in 6.9% of cases and coexisting lung cancer (1.72%). After 6 months of the operation, there were statistically significant improvements in the values of FEV1, 6MWT, MMRC, BMI, quality of life, but with a constant decrease at 12 and 24 months. Average increase in FEV1 after 24 months of bullectomy, unilateral and bilateral LVRS (210mL/230mL/550mL). Average increase in the 6MWT parameter by groups 24 months after surgery (42.26m/48.61m/43.50m). The one-year decline in FEV1 was significant in the bilateral LVRS group (240 ml/g), but was not significant in the bullectomy and unilateral LVRS group (80 ml/g). After surgery, the average BMI has an increasing trend, there is a statistically significant decrease in dyspnea. After surgery, 89.5% to 100% of patients did not use steroid therapy, and 63.2% - 75% of patients declared that their quality of life was better or much better. The results of preoperative tests in correlation with the morphology of emphysema, along with the analysis of the pathoanatomic substrate and the applied resection, could contribute to the identification of patients who, with an acceptable surgical risk, will benefit from surgical treatment. Hirurgija - Grudna hirurgija / Surgery - Thoracic surgery Datum odbrane: 01.10.2024. emfizem pluća, HOBP, bulektomija, hirurška redukcija plućnog volumena(LVRS) lung emphysema, COPD, bullectomy, lung volume reduction surgery (LVRS) 616.24-089-036.8(043.3) 91552100 189720329 91552101 10274 2026-04-01T10:14:11.053Z 45 no 46 Slaviša, 1968- Baščarević 15186535 2024 63 mentor Maja, 1962- Ercegovac 12944999 2024 63 član komisije Tatjana, 1970- Adžić Vukičević 74816521 2024 63 član komisije Milan, 1975- Savić 55547657 2024 63 član komisije Nebojša, 1973- Marić 5724263 2024 131, 2 str. 4575635 http://phaidrabg.bg.ac.rs/o:38542 no yes 12 2026-04-01T10:14:11.320Z 70 11 1066950 1067017 emfizem pluća, HOBP, bulektomija, hirurška redukcija plućnog volumena(LVRS) lung emphysema, COPD, bullectomy, lung volume reduction surgery (LVRS) 616.24-089-036.8(043.3) 1738 11A32 2024