经支气管镜活瓣置入肺减容术研究进展  

Advances in bronchoscopic lung volume reduction using endobronchial valves

作　　者：孙康 潘蕾 金发光 Sun Kang;Pan Lei;Jin Faguang(Department of Respiratory and Critical Care Medicine,Tangdu Hospital,Air Force Military Medical University,Xi'an 710032,China;Department of Respiratory and Critical Care Medicine,Air Force Medical Center,Beijing 100000,China)

机构地区：[1]空军军医大学唐都医院呼吸与危重症医学科,西安710032 [2]空军特色医学中心呼吸与危重症医学科,北京100000

出　　处：《国际呼吸杂志》2020年第23期1835-1840,共6页International Journal of Respiration

基　　金：陕西省科技计划项目(2020SF-112)。

摘　　要：重度肺气肿由于肺过度充气,导致缺氧症状甚至呼吸衰竭,是不可逆转的进行性发展的慢性呼吸系统疾病,药物治疗效果差。经过不断探索,外科肺减容术和经支气管镜肺减容术获得了长足的发展,经支气管镜活瓣置入肺减容术是目前唯一可逆的、并达到临床应用证据水平的内科肺减容术,具有与外科肺减容术相同的获益,但侵入性更小、并发症和病死率更低,已被慢性阻塞性肺疾病全球倡议指南、英国国家卫生与临床优化研究所推荐作为重度肺气肿患者的一种治疗选择。支气管内活瓣可致靶肺叶不张,降低肺过度充气,最终改善患者肺功能和临床症状。手术的成功取决于精准的患者选择、靶肺叶确定以及靶肺叶和临近肺叶间无侧支通气。现已证明,无论异质型或均质型肺气肿均可获益,对术后并发症的预知和积极管理可最大程度减少手术相关风险。Because of hyperinflation,patients with severe emphysema can result in hypoxia symptoms and even respiratory failure.Severe emphysema is an irreversible progressive chronic respiratory disease in which drug treatment has poor effects.After continuous exploration,lung volume reduction surgery and endoscopic lung volume reduction got a great development.Bronchoscopic lung volume reduction using endobronchial valves is currently the only reversible endoscopic lung volume reduction,which meets the criteria of clinical application.It has the same benefit as surgical lung volume reduction,but it is less invasive and has less complications and lower mortality.It has been recommended by the GOLD and UK/NICE guidelines as a treatment option for patients with severe emphysema.Endobronchial valves can cause target lung lobe atelectasis,reduce hyperinflation,and ultimately improve pulmonary function and clinical symptoms.The success of the operation and the maximum benefit of the patients depend on the accurate selection of patient and the target lobe and negative collateral ventilation between the target lobe and the adjacent lobe.Either heterogeneous or homogeneous emphysema has been proven to benefit from this procedure.Prediction and active management of postoperative complications can minimize the risk of surgical complications.

关 键 词：肺气肿 经支气管镜肺减容术 支气管内活瓣 过度充气 侧支通气 

分 类 号：R655.3[医药卫生—外科学]