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目的应用国产单向活瓣支架进行可弯曲支气管镜介入肺减容术(BILVR)临床研究,初步探索其安全性和疗效。方法2006年5月至2007年8月对7例重度肺气肿患者经胸部CT扫描确定靶位,在全身麻醉下行可弯曲支气管镜及X线引导支架置入。观察患者的临床症状、肺功能、血气分析、超声、6min步行距离(6MWD)及影像学表现。结果7例患者在单侧上叶支气管段或亚段放置4～6枚支架,手术时间为(136±72.3)min。术后2h可自行活动,呼吸困难明显减轻。术后影像学检查显示支架远端支气管聚拢,但未见肺不张。术后2周6MWD、Brog呼吸困难评分和肺动脉压差异有统计学意义(P<0.05)。肺功能、血气分析及靶区肺体积无明显变化。1例患者在术后2d出现非靶区下叶肺炎、1例患者出现慢性阻塞性肺疾病急性发作,均治疗后缓解。其余患者均未出现严重并发症。结论BILVR可能会改善极重度肺气肿患者呼吸困难的症状和生活质量,较为安全。
Objective To evaluate the safety and curative effect of bendable bronchoscopic interventional lung volume reduction (BILVR) using a domestic one-way valve stent. Methods From May 2006 to August 2007, 7 patients with severe emphysema underwent CT scan of the thorax to determine the target and underwent flexible bronchoscope and X-ray stenting under general anesthesia. The clinical symptoms, lung function, blood gas analysis, ultrasound, 6MWD distance and imaging findings were observed. Results In 7 patients, 4 to 6 stents were placed in the unilateral upper lobe bronchial segment or sub-segment. The operation time was (136 ± 72.3) min. 2h after surgery can be self-activity, breathing difficulties significantly reduced. Postoperative imaging showed that the stent distal bronchial gathered, but no atelectasis. Postoperative 2 weeks 6MWD, Brog dyspnea score and pulmonary arterial pressure differences were statistically significant (P <0.05). Lung function, blood gas analysis and target lung volume did not change significantly. One patient developed non-target leaflet pneumonitis 2 days after operation, and one patient developed acute exacerbation of chronic obstructive pulmonary disease. All patients were relieved after treatment. The remaining patients did not have serious complications. Conclusion BILVR may improve the symptoms and quality of life in patients with very severe emphysema, which is more safe.