经支气管镜生物学肺减容术研究  

Experimental study on biological lung volume reduction

作　　者：孙元亮[1] 方年新[2] 陈正贤[1] 刘思怡[1] 杨嘉雯[1] 黄俊伟[1] 

机构地区：[1]广东省人民医院(广东省医学科学院)呼吸内科,广东广州510081 [2]东莞市人民医院呼吸内科,广东东莞523081

出　　处：《临床肺科杂志》2014年第8期1359-1362,共4页Journal of Clinical Pulmonary Medicine

基　　金：广东省医学科研基金项目(No B2010011)

摘　　要：目的探讨一种新型经支气管镜肺减容术的安全性和可行性。方法新西兰兔6只,麻醉后经口插入超细支气管镜观察新西兰兔肺,通过工作通道注入胰蛋白酶2 ml停留2 min,吸除,再次注入细胞培养液2 ml停留30 s,吸引干净,通过工作通道导入冠脉血管导丝,退镜,通过导丝导入双腔管,同时插入超细支气管镜观察是否到位,通过2个管腔同时注入滑石粉混悬液0.2 ml,然后分别注入生物蛋白胶1.25 ml,退除双腔管和超细支气管镜,用影像学(CT,术后1天,2、6、12周)和组织病理学方法(术后12周)观察减容效果。结果所有操作过程顺利,未发现技术操作上的困难,1只动物死于麻醉意外,其他术后无明显并发症;术后12周CT检查示5只兔局部肺组织均呈密度增高致密影,未见炎性病变影像,病理检查肉眼见肺组织萎陷、容积明显缩小,低倍镜下见纤维母细胞增生,部分纤维化。结论应用滑石粉和生物蛋白胶的经支气管镜生物学肺减容术创伤小、并发症少,并能达到持续充分的肺减容。Objective To investigate the safety and feasibility of a new transbronchoscopic way of lung volume reduction. Methods Tracheas of 6 postanesthetic New Zealand rabbits were observed by a superfine bronchoscope. 2ml trypsinase and 2ml cell culture fluid were then injected to the tracheas retaining for 2 minuts and 30 seconds before resorption successively. Subsequently,a coronary vascular guidewire was intromit through the work chennel into the trachea and guided a bi-lumens tube to enter the trachea after the superfine bronchoscope was pulled out.The superfine bronchoscope was then intromitted into the trachea once again for observation to confirm the bi-lumens tube was on the right position. 0. 2ml talc Powder Suspension and 1. 25ml bioprotein glue were injected successively into both the lumens. Finally the bi-lumens tube and superfine bronchoscope were pulled out simultaneously. CT was applied on the 1st day,the 2nd,6th and 12th weeks after this manipulation and finnally histopathologic examination for the experimental lung tissues was carried out to examine the effectiveness of lung volum reduction. Results The procedures were well finished without any difficulties. There was not any evident complication takening place on the rabbits except a rabbit died from anesthetic accident. The outcome of CT examinations 12 weeks after the operations showed dense shadows in all the experimental lung tissues without evidens of inflammatory lesions. Histopathologic examinations indicated that the experimental lung tissues Collapsed with obviously decreased sizes,which were observed by eyes,and developed fibroblas proliferations with some of them fibering showed by lower power lens. Conclusion The transbronchoscopic way of lung volume reduction used talc powder and bioprotein glue with minor trauma and complication can perform continuing and sufficient reduction of lung volum.

关 键 词：支气管镜 肺减容 COPD 

分 类 号：R655.3[医药卫生—外科学]