Lung volume reduction surgery in canine model of predominantly upper lobe emphysema
Lung volume reduction surgery in canine model of predominantly upper lobe emphysema
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DOI：
10.1378/chest.125.2.633
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发表时间：
2004-02-01
期刊：
影响因子：
9.6
通讯作者：
Tan, L
中科院分区：
文献类型：
--
作者：
Mink, SN;Gonzalez, X;Tan, L
目的：肺减容术已被证明是治疗晚期肺气肿的有效方法。然而，长时间的空气泄漏是限制这一手术实用的一个重要并发症。这项研究评估了一种新的手术系统的安全性和有效性，该手术系统旨在将这种并发症降至最低。方法：在14只狗身上，通过反复注入木瓜酶，在大约6个月的间隔内，产生严重的上叶肺气肿。在手术组中，在基线、肺气肿后、切除后1个月和6个月进行肺功能测试，包括肺容量和肺血流，而非手术组在相同的时间间隔进行。7只动物被随机分配到手术组，以测试真空辅助手术系统(Valr Surgical System；Spation；Redmond，WA)，该系统在部分病变组织上部署压缩硅胶套管。结果：与基线相比，肺气肿使两组犬的总肺活量(TLC)增加了约125%。在手术组，与肺气肿后的测量相比，手术组在切除后没有观察到空气泄漏，TLC在I个月和6个月期间显著降低。在尸检中，组织学检查显示袖子内有受压肺的纤维化和纤维包裹的装置。两只动物都有局部感染的证据。结论：我们成功地建立了一种以上叶肺气肿为主的模型。真空辅助手术系统提供了安全有效的肺复位术，无漏气并发症，肺功能持续改善超过6个月。
Objective: Lung volume reduction surgery has been shown to be an effective treatment for selected patients with advanced emphysema. Nevertheless, prolonged air leaks are a significant complication that limits the utility of this procedure. This study evaluated the safety and effectiveness of a novel surgical system designed to minimize this complication.Methods: In 14 dogs, severe upper lobe emphysema was produced by repeated bronchial instillations of papain administered over an approximate 6-month interval. Pulmonary function testing that included lung volumes and flows was performed at baseline, after emphysema, and at 1 month and 6 months after resection in the surgical group, while at comparable intervals in the nonsurgical group. Seven animals were randomly assigned to a surgical group to test a vacuum-assisted surgical system (VALR Surgical System; Spiration; Redmond, WA) that deploys a compression silicone sleeve over portions of the diseased tissue. The other seven dogs comprised the nonsurgical group.Results: In both groups, emphysema increased total lung capacity (TLC) approximately 125% as compared to baseline. In the surgical group, no air leaks were observed after resection, and TLC significantly decreased at the I-month and 6-month periods as compared with postemphysema measurements. At necropsy, histologic examination revealed fibrosis of the compressed lung contained within the sleeve and fibrotic encapsulation of the device. Two animals had evidence of localized infection.Conclusion: We successfully created a model of predominantly upper lobe emphysema. The vacuum-assisted surgical system provided safe and effective lung reduction without air leak complications and with sustained improvement in pulmonary function over 6 months.