肺气肿的支气管镜介入治疗现状  

Current status of interventional therapy for pulmonary emphysema with bronchoscopy

作　　者：陈伶俐 李毅 潘频华[1] CHEN Lingli;LI Yi;PAN Pinhua(Department of Respiratory Medicine,Branch of National Clinical Research Center for Respiratory Disease,Xiangya Hospital,Central South University,Changsha 410008;Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院呼吸内科,国家呼吸系统疾病临床医学研究中心分中心,长沙410008 [2]呼吸疾病智能诊疗技术湖南省工程研究中心,长沙410008

出　　处：《中南大学学报（医学版）》2022年第5期665-672,共8页Journal of Central South University ：Medical Science

基　　金：国家自然科学基金(81770080)。

摘　　要：肺气肿是一种可进展为慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)的肺部疾病表型,发病机制复杂,与吸烟、感染、基因突变及空气污染等密切相关。肺部终末细支气管远端的气道弹性减退、过度膨胀、充气,伴有气道壁的破坏是肺气肿的典型病理状态。随着COPD发病率及病死率逐年上升,肺气肿的治疗成为了研究热点。针对肺气肿的药物治疗疗效有限,目前主要依靠手术治疗。通过手术切除病变肺组织(肺减容术)的方法自20世纪50年代提出后,经美国国家肺气肿治疗实验证实其可有效改善肺功能和提高运动耐力,但创面大、病死率高和花费昂贵等问题使其临床获益降低。近年来联合支气管镜技术的肺减容术,包括支气管镜单向阀技术、支气管镜线圈、生物胶封堵、经支气管镜热蒸汽消融术等,在保证有效性的前提下具备微创、病死率低和并发症少等优点。因此总结肺气肿的介入治疗技术现状,归纳各种介入治疗技术的特点和适用人群,可为患者尽早转诊和临床医生决策提供理论支持。Pulmonary emphysema is one of phenotypes of lung disease that can progress to chronic obstructive pulmonary disease(COPD).The pathogenesis is unknown,which may be closely related to smoking,infection,gene mutation,and air pollution.Pathological features of emphysema include the decreased airway elasticity at the distal end of the bronchioles and over-hyperinflation.As the incidence and mortality of COPD increase,emphysema has become the focus of research.The efficacy of drugs for COPD is limited,and currently the treatment of emphysema mainly depends on surgery.Since the concept of lung volume reduction surgery was proposed in the 1990s,many studies have confirmed improvement of lung function and exercise capacity,but the large wound,high mortality,and high cost have reduced its benefits.Lung volume reduction surgery with bronchoscopy technology,including valves,coils,sclerosants,vapor thermal ablation,etc.,has the advantages of minimal invasive and decreased mortality under the basis of effectiveness.This article aims to review the current status of interventional therapy for pulmonary emphysema with bronchoscopy,compare and summarize the characteristics and applicable populations of interventional therapy,and provide theoretical support for patients’early referral and clinicians’decision-making.

关 键 词：肺气肿 经支气管镜肺减容术 单向阀 线圈 热蒸汽消融 

分 类 号：R563.3[医药卫生—呼吸系统]