经支气管镜置入单向支气管活瓣治疗重度/极重度慢性阻塞性肺疾病2例  

Bronchoscopic lung volume reduction with one-way bronchial valve in treatment of severe and extremely severe chronic obstructive pulmonary diseases: two cases report

作　　者：匡煜坤[1] 陈凤佳[1] 朱智文[1] 

机构地区：[1]中山大学附属第一医院呼吸内科,广州510080

出　　处：《新医学》2015年第2期132-136,共5页Journal of New Medicine

摘　　要：近年来,以经支气管镜肺减容(BLVR)为代表的内科肺减容术越来越受到人们的关注。该文报道了2例采用Zephyr单向支气管活瓣进行BLVR治疗的重度/极重度COPD患者的诊治经过及随访情况。2例患者根据病史及辅助检查分别诊断为重度、极重度COPD且内科药物治疗效果欠佳,其胸部CT均示双侧非均质性肺气肿且以双肺上叶明显。结合术前胸部CT结果及术中Chart's系统测定肺叶间旁路通气情况,均选择右肺上叶为靶肺叶。采用可弯曲支气管镜于右肺上叶尖后前各段(B1、B2、B3)分别置入Zephyr单向支气管活瓣各1枚。术后患者均生存,且无发生严重并发症。分别随访1、6个月,2例患者的生活质量、运动耐量及肺功能指标等方面均有不同程度的改善,复查胸部CT均示右肺上叶不张、容积缩小。该2例的成功治疗经验提示,采用Zephyr单向支气管活瓣进行BLVR治疗经过严格筛选的重度/极重度COPD可取得一定的效果。Recently,lung volume reduction,represented by bronchoscopic lung volume reduction（ BLVR）,has captivated more and more attention from physicians. In this study,two patients with severe and extremely severe chronic obstructive pulmonary diseases（ COPD） were treated with BLVR with Zephyr one-way bronchial valve. The diagnosis,treatment and subsequent follow-up of these two patients were reported. Based upon medical history and accessory examination,two patients were diagnosed with severe and extremely severe COPD. Medical therapy yielded poor clinical efficacy. Chest CT revealed bilateral heterogeneous emphyse mainly in lobi superior. Combining with preoperative chest CT and lobe bypass ventilation assessed by Chartis system intraoperatively,superior lobe of the right lung was selected as the target lobe. Each Zephyr one-way bronchial valve was placed into the apex of lung,anterior and posterior lung（ B1,B2 and B3）. Postoperatively,both patients survived and had no severe complications. These two cases were followed up for 1 and 6months. Quality of life,exercise tolerance and lung function were improved of varying degree. Chest CT revealed atelectasis and volume reduction of the superior lobe of right lung. Successful treatment of two cases demonstrated that BLVR with Zephyr one-way bronchial valve has some efficacy in treatment of strictly screened severe / extremely severe COPD.

关 键 词：单向支气管活瓣 经支气管镜肺减容 慢性阻塞性肺疾病 非均质性肺气肿 

分 类 号：R563.9[医药卫生—呼吸系统]