全身麻醉单向活瓣肺减容支架放置与取出技术

Study on transbronchoscopic interventional treatment with one-way valve stent in severe emphysema

目的应用国产单向活瓣支架进行可弯曲支气管镜介入肺减容术（BILVR）临床研究，初步探讨支架的放置与取出技术。方法选择2006年5月至2008年3月8例重度肺气肿患者，其中男性7例，女性1例，年龄43-70岁。在全身麻醉下行可弯曲支气管镜支架置入，其中对2例患者行全部或部分取出支架。结果8例患者在单侧上叶支气管段或亚段放置4～6个支架，手术时间为（124．00±63．26）min。术后2h可自行活动，呼吸困难明显减轻。1例患者在术后2d出现非靶区下叶肺炎、1例患者出现慢性阻塞性肺疾病急性发作，均治疗后缓解。其余患者均未出现严重并发症。随访6～24个月，2例部分支架远端出现肺炎，行全身麻醉经纤维支气管镜支架取出术，未出现严重并发症。结论全身麻醉单向活瓣肺减容支架的放置与取出术操作简单．较为安全。

Objective To evaluate the technique of implanting and withdrawing the domestic-made stents in the study on clinical application of bronchoscopic interventional lung volume reduction. Methods From May 2006 to March 2008,8 cases with severe emphyseme, male 7, female 1, aged 43 - 70 years,were implanted flexible stents under general anesthesia. Among them total or partial withdrawal were performed in 2 patients. Results Four to six stents per patient were implanted into the obstructed upper-lobe branchial segments unilaterally with operation time （ 124.00 ± 63.26） min. All patients could walk in 2 hours after operation, their dyspnea relieved obviously. No major life-threatening complications were found. Lower-lobe pneumonia developed in 1 patient and 1 patient occurred acute episode of chronic obstructive pulmonary disease （COPD）. Pneumonia occurred in 2 patients during following-up 6 - 24 months. Stems withdrawal were performed in 2 patients due to the distal end pneumonia. Conclusion The technique of stents implantation and withdrawal with one-way value stent lung volume reduction under general anesthesia is convenient and comparatively safe.