中国实用内科杂志 ›› 2013, Vol. 33 ›› Issue (2): 105-108.

• 专题笔谈 • 上一篇    下一篇

支气管镜肺减容现状和展望

孙沁莹1校译,林冰2   

  1. 作者单位:1.第二军医大学附属第一医院呼吸科,上海 200433;2.香港养和医院呼吸系统科,中国香港
  • 出版日期:2013-01-31 发布日期:2013-01-31
  • 作者简介:林冰,香港养和医院呼吸科主任,英国皇家内科医学院院士。研究方向是肺癌的早期诊断,气道疾病,经支气管镜肺减容治疗重度慢性阻塞性肺疾病(COPD)和难治性气胸,睡眠呼吸相关性疾病及感染性疾病。

Current status and prospects of lung volume reduction surgery.

SUN Qin-ying*,LIN Bing.   

  1. *Department of Respiratory Diseases,Changhai Hospital,Second Military Medical University,Shanghai 200433,China
  • Online:2013-01-31 Published:2013-01-31

摘要:

外科肺减容手术治疗重度肺气肿术后病死率较高,适应证少,不适宜临床推广。支气管镜肺减容术通过支气管镜下的技术操作,简便、安全,有望替代外科肺减容术治疗重度肺气肿。目前研究比较有效的方法有支气管腔内单向阀、生物胶、蒸汽消融和肺减容线圈。支气管镜肺减容术治疗重度肺气肿,可以明显改善气促指数、6 min步行距离及生活质量(SGRQ)评分等主观指标,但对于评价该项技术有效性的客观指标如肺功能指标及运动耐力仅有部分改善。采用该项技术安全性好,住院时间短,极少出现危及生命的严重并发症,可能出现的并发症包括慢性阻塞性肺疾病急性加重、肺炎和气胸。下一步需开展前瞻性的随机对照研究,证实支气管镜肺减容术的确切疗效。

关键词: 支气管镜肺减容术, 均质性肺气肿, 非均质性肺气肿, 支气管腔内单向阀, 生物胶, 蒸汽消融, 肺减容线圈

Abstract:

Abstract:The application of lung volume reduction surgery (LVRS) in clinical practice is limited by high postoperative morbidity and stringent selection criteria.Bronchoscopic lung-volume reduction has recently been explored as safer alternatives to LVRS for treating advanced emphysema.The currently available data on efficacy of bronchoscopic lung volume reduction are not conclusive and subjective benefit in dyspnoea scores,6MWT distance (6MWD),quality of life (SGRQ) are more frequent findings than improvements on spirometry or exercise tolerance.Safety data are more promising with rare procedure-related mortality,short hospital length of stay and few complications such as COPD exacerbation,peumonia,pneumothorax.The field of bronchoscopic lung volume reduction continues to evolve as ongoing prospective randomized trials build on earlier feasibility data to clarify the true efficacy of such techniques.

Key words: bronchoscopic lung-volume reduction, homogeneous emphysema, heterogeneous emphysema, endobronchial valves, biological sealants, thermal vapor ablation, the lung volume reduction coil

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