经支气管镜单向活瓣肺减容术实施策略

Implementation strategy of bronchoscopic lung volume reduction with endobronchial valve implants

目的对经支气管镜单向活瓣肺减容术的临床应用适应证、禁忌证和操作要点等问题作扼要叙述,希望能对其规范化应用起到抛砖引玉的作用。方法根据中华医学会呼吸病学分会介入性肺病学组2011年"单向活瓣肺减容术专题座谈会"内容,结合国内外研究成果整理而来。结果适应证选择对疗效的影响最重要:①肺气肿病变呈高度异质性及其以上叶病变为著者效果较佳;②叶间裂完整者存在旁路通气的风险低,效果较好。结论经支气管镜单向活瓣肺减容术作为经支气管镜肺减容术(BLVR)中比较成熟的手术方式,具有创伤小、操作简单、安全性好等优点。术中采用Chartis系统检测旁路通气是目前评估靶肺叶与相邻肺叶间有无旁路通气的"金标准"。放射性核素肺通气/灌注扫描观察患者术后通气/血流比值是否更趋合理,是判断其疗效的"金标准"。

[Objective]To briefly narrate the clinical indication,contraindication and operation points of bronchoscopic lung volume reduction with endobronchial valve implants,hoping that it would use the little to get the big on its standard application.[Methods]According to the content of the Lung Volume Reduction with Endobronchial Valve Implants Forum held by the Interventional Lung Diseases Group of Chinese Medical Association,this article was sorted out combined with research achievements at home and abroad.[Results]Indication selection is the most important factor for curative effect.① It may have better effect with highly heterogeneous emphysema and significant disease in superior lobe.② Patients with intact interlobaris fissurae have low risk of collateral ventilation and better effect.[Conclusion]Bronchoscopic lung volume reduction with endobronchial valve implants,as a comparatively mature surgery method in bronchoscopic lung volume reduction（BLVR）,has advantages such as minimal trauma,simple operation and good safety.Using Chartis system to check collateral ventilation is the gold standard of evaluating collateral ventilation between target pulmonary lobe and nearby lobe at present.To observe if the ventilation-perfusion ratio tends to be more reasonable after surgery by radioactive lung ventilation-perfusion scanning may be the gold standard for evaluating its efficacy.