Bronchoscopic Interventions for Chronic Obstructive Pulmonary Disease.
Bronchoscopic Interventions for Chronic Obstructive Pulmonary Disease.
复制标题
慢性阻塞性肺疾病的支气管镜干预。
DOI：
10.1111/resp.12362
复制
发表时间：
2014
期刊：
影响因子：
6.9
通讯作者：
Slebos DJ.
中科院分区：
文献类型：
--
作者：
Mineshita M;Slebos DJ.
在过去的十年中，一些非手术和微创支气管镜肺减容（BLVR）技术已经被开发用于治疗严重慢性阻塞性肺疾病（COPD）患者。BLVR可以非常有效，适用于广泛的患者队列，并且在合理的费用下具有可靠的安全性。BLVR的引入也有望加速全球介入性肺病学的进一步发展。最近，BLVR技术的临床研究结果已经发表，提供了关于该手术的适应症、禁忌症、患者选择标准和结果的有价值的信息。由于确定了最佳应答者，利用单向支气管内瓣膜的BLVR在常规医疗实践中作为一种可接受的治疗正在获得势头。非均匀肺气肿分布和无叶间侧支通气的患者表现出令人鼓舞的结果。此外，对于不适合瓣膜治疗的侧支通气患者和均质性肺气肿患者，引入肺减容线圈治疗是一种很有希望的解决方案。此外，随着新的治疗方式的发展，即生化密封剂和热水蒸气，治疗肺气肿的潜力可能会进一步增加，而不考虑侧支流。然而，BLVR治疗的患者选择对于手术的成功至关重要，应该采用多学科团队的方法进行。因此，BLVR需要集中在高容量的中心，以提供更好的质量和治疗挑战和不良事件的体验。本文从专家和科学的角度对BLVR进行了综述。
Over the past decade, several non‐surgical and minimally invasive bronchoscopic lung volume reduction (BLVR) techniques have been developed to treat patients with severe chronic obstructive pulmonary disease (COPD). BLVR can be significantly efficacious, suitable for a broad cohort of patients, and associated with a solid safety profile at a reasonable expense. The introduction of BLVR is also expected to accelerate the further development of interventional pulmonology worldwide. Recently, results from clinical studies on BLVR techniques have been published, providing valuable information about the procedure's indications, contraindications, patient‐selection criterion and outcomes. BLVR utilizing one‐way endobronchial valves is gaining momentum as an accepted treatment in regular medical practice because of the identification of best responders. Patients with a heterogeneous emphysema distribution and without inter‐lobar collateral ventilation show encouraging results. Furthermore, for patients with collateral ventilation, who are not considered candidates for valve treatment, and for patients with homogeneous emphysema, the introduction of lung volume reduction coil treatment is a promising solution. Moreover, with the development of newer treatment modalities, that is, biochemical sealant and thermal water vapor, the potential to treat emphysema irrespective of collateral flow, may be further increased. Nevertheless, patient selection for BLVR treatment will be crucial for the procedure's success and should be performed using a multidisciplinary team approach. Consequently, BLVR needs to be concentrated in high‐volume centres that will offer better quality and experience with treatment challenges and adverse events. This review gives a general overview of BLVR from an expert and scientific perspective.