Bronchoscopic lung volume reduction
Bronchoscopic lung volume reduction
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DOI：
10.1097/00128594-200307000-00024
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
F. Venuta;E. Rendina;T. Giacomo;G. Coloni
中科院分区：
文献类型：
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作者：
F. Venuta;E. Rendina;T. Giacomo;G. Coloni
肺气肿是一种使人衰弱的肺部疾病，在发达国家仍然是发病率和死亡率的主要来源。药物治疗是治疗的主要手段，包括戒烟、肺康复、支气管扩张剂给药，以及在有指征时使用类固醇和补充氧气。过去曾推广各种外科手术来缓解晚期肺气肿患者的呼吸困难并改善其生活质量;虽然早期结果通常令人鼓舞，但很少实现持续的客观功能改善，并且大多数手术逐渐被放弃。尽管存在争议，但LVRS已被证明对药物治疗失败的终末期肺气肿患者有益。毫无疑问，LVRS可以在选定的一组患者中实现显著的功能改善;然而，即使在具有较大经验的中心死亡率较低，LVRS仍然具有相当高的发病率。最晚期功能恶化的患者显示出较高的手术死亡率和较不令人印象深刻的功能结果，这表明在这些情况下应更仔细地考虑LVRS。最近已经提出了外科手术方法的支气管镜替代方案，其中一些可能在未来发挥重要作用;特别是气道旁路和支气管镜肺减容术与单向阀肯定是其临床应用的一个步骤。我们在此报告这些新治疗方案的初步实验和临床经验。
Emphysema is a debilitating lung disease continuing to be a major source of morbidity and mortality in the developed countries. Medical treatment is the mainstay of therapy and consists of smoking cessation, pulmonary rehabilitation, administration of bronchodilators and, when indicated, steroids and supplemental oxygen. Various surgical procedures have been promoted in the past to relieve dyspnoea and improve quality of life in patients with advanced emphysema; whilst early results were often encouraging, a sustained objective functional improvement was rarely achieved and most of those procedures were progressively abandoned. Despite controversies, LVRS has been shown to be beneficial to selected patients with end-stage emphysema when medical therapy has failed. There is no doubt that LVRS allows a significative functional improvement in a selected group of patients; however, it still carries a substantial morbidity, even if mortality is low at the centers with the larger experience. Patients with a most advanced functional deterioration show a higher surgical mortality and less impressive functional results, suggesting that LVRS should be considered more carefully in these situations. Bronchoscopic alternatives to the surgical approach have been recently proposed and some of them may play an important role in the future; in particular, the airway bypass and bronchoscopic lung volume reduction with oneway valves are certainly one step beyond on their way to clinical application. We hereby report the initial experimental and clinical experience with these new treatment options.