经支气管镜肺减容术的实验研究

An experimental study of bronchoscopic lung volume reduction medicine

目的评价自主研制单向活瓣栓子治疗羊重度肺气肿的有效性及安全性。方法采用与北京普益盛济科技有限公司合作研制的单向活瓣栓子，在解放军总医院动物实验中心进行动物实验。选择12-18个月龄健康雄性山羊12只，在支气管镜直视下向靶肺段置入自主研制的单向活瓣栓子，每只羊平均置入3枚，观察并记录实验动物的耐受性，分别于术后2、4、8和12周进行动脉血气测定和胸部CT扫描，观察栓子附近支气管组织及远端肺组织标本的病理变化。采用SPSS 13．0统计软件进行数据分析，各时间点血气分析结果比较采用组间t检验。结果36枚栓子全部经支气管镜顺利置入。所有实验羊在观察期内的耐受性良好，置入栓子共脱落3枚。胸部CT示33枚栓子中有15枚（45％）栓子远端肺组织可见不同程度的萎缩或膨胀不全。组织病理学示肺泡腔缩小、塌陷，肺间质内可见淋巴细胞和单核细胞浸润，伴有少许纤维组织增生。结论该单向活瓣栓子的性能稳定，栓子可经支气管镜活检通道直视下一次性置入，定位准确，组织相容性好，动物的耐受程度良好，可达到一定的肺减容效果，改良后有望用于重度肺气肿的临床治疗。

Objective To evaluate the effect and safety of experimental bronchoscopic lung volume reduction （BLVR） using an one-way valve designed independently. Methods The animal study was carried out from June to December 2008. Totally 36 valves were implanted in the target bronchi of 12 healthy male goats. CT scan, artery blood gas exchange and lung pathology were performed after 2, 4, 8 and 12 weeks. Results All the valves were implanted successfully, but 3 valves were expectorated at the end. The procedure was well tolerated. CT scan showed that for more than 45% （15/33） of the valves, the target lung tissue had collapsed. Lung pathology showed that the alveolar space was deflated and collapsed. Lymphocytes and monocytes infiltrated the interstitial tissue with some degree of fibrosis. Conclusions This animal study showed that the independently manufactured one way valve was effective and safe. The one way valve may be useful in the treatment of severe emphysema in the future.