单向活瓣支架介入治疗重度肺气肿的临床研究  

An preliminary clinical study of transbronchoscopic interventional treatment for severe emphysema with local made one-way valvular stents

作　　者：范勇[1] 吴琦[1] 梁春宝[1] 吴先杰[1] 田静[1] 杜钟珍[1] 李萍[1] 武俊平[1] 史丽霞[1] 赵崇法[1] 李玉萍[1] 于蕾[1] 贺能树[2] 

机构地区：[1]天津市海河医院放射科,300350 [2]天津医科大学总医院

出　　处：《介入放射学杂志》2008年第3期186-189,共4页Journal of Interventional Radiology

摘　　要：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 efficiency of bronchoscopic interventional lung volume reduction with domestic-made stents.Methods The target areas of 7 patients with severe emphysema for valvular stenting form May 2006 to Aug.2007 were prospectively selected on the basis of CT scan.Under general anesthesia,one-way valvular stenting were carried out over a guidewire under flexible bronchoscopy and fluoroscopic control.The symptom,pulmonary function,blood gas analysis,B-ultrasonic wave,6 minute walk distance and thoracic CT were undertaken.Results 4-6 stents per patient took place in 136 ± 72.3 min to obstruct the upper-lobe segments unilaterally but without obvious atelectasis under imaging.The patients could walk 2 hours after the operation with relief of dyspnea.No major change in radiologic findings and lung function occurred in 2 weeks,only bronchi distal to the stents gathered together.6-min walk distance,Borg dyspnea scale fell and the pulmonary arterial pressure showed significant（P 〈 0.05）statistical discrepancy.No major life-threatening complications were noted in the 15-day study period and no conspicuous change in lung function,blood gas analysis and lung volume.Lower-lobe pneumonia of nontarget area developed in 1 patient and acute episode of COPD occurred in another.Conclusions Bronchoscopic interventional lung volume reduction may improve dyspnea and quality of life,as a rather safety therapeutic measure.

关 键 词：肺气肿 单向活瓣支架 介入放射学 支气管镜 

分 类 号：R563.3[医药卫生—呼吸系统]