Bronchoscopic lung volume reduction in severe emphysema.
Bronchoscopic lung volume reduction in severe emphysema.
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DOI：
10.1513/pats.200707-085et
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发表时间：
2008-05
期刊：
影响因子：
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通讯作者：
E. Ingenito;D. Wood;J. Utz
中科院分区：
文献类型：
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作者：
E. Ingenito;D. Wood;J. Utz
肺减容手术(LVRS)在选择的晚期肺气肿患者中产生生理、症状和生存方面的益处。由于它与显著的发病率、死亡率和成本相关，因此已经开发了非手术替代方法来实现体积减少。三种支气管镜肺减容(BLVR)方法已经显示出希望，并进入了后期临床试验。这些措施包括：(1)放置支气管内单向瓣膜，旨在通过阻断吸气流动来促进肺不张；(2)使用射频导管形成气道旁路，旨在促进呼气时间较长的受损肺区域的排空；以及(3)注入生物粘合剂，旨在塌陷和重塑过度膨胀的肺。目前有限的临床数据表明，这三种技术都相当安全。然而，与LVRS后观察到的相比，疗效信号明显更小，耐用性更差。优化患者选择、改进治疗策略、确定程序安全性、阐明作用机制以及确定这些方法的短期和长期有效性的研究正在进行中。结果将在未来几年内公布，并将确定BLVR是否代表着LVR的安全和有效的替代品。
Lung volume reduction surgery (LVRS) produces physiological, symptomatic, and survival benefits in selected patients with advanced emphysema. Because it is associated with significant morbidity, mortality, and cost, nonsurgical alternatives for achieving volume reduction have been developed. Three bronchoscopic lung volume reduction (BLVR) approaches have shown promise and reached later-stage clinical trials. These include the following: (1) placement of endobronchial one-way valves designed to promote atelectasis by blocking inspiratory flow; (2) formation of airway bypass tracts using a radiofrequency catheter designed to facilitate emptying of damaged lung regions with long expiratory times; and (3) instillation of biological adhesives designed to collapse and remodel hyperinflated lung. The limited clinical data currently available suggest that all three techniques are reasonably safe. However, efficacy signals have been substantially smaller and less durable than those observed after LVRS. Studies to optimize patient selection, refine treatment strategies, characterize procedural safety, elucidate mechanisms of action, and characterize short- and longer-term effectiveness of these approaches are ongoing. Results will be available over the next few years and will determine whether BLVR represents a safe and effective alternative to LVRS.