镜下射频置管肺减容术在肺气肿绵羊的应用

The application of establishing airway bypass by bronchoscopic radio frequency catheter lung volume reduction in the sheep model of pulmonary emphysema

目的探讨经纤支镜射频置管建立气道旁路肺减容术治疗绵羊肺气肿模型的有效性及优越性。方法将16只6个月龄雌性绵羊随机分为A、B两组,木瓜蛋白酶方法建立肺气肿模型。A组经纤支镜射频建立气道旁路并放置支架,给予内科治疗,B组仅给予常规内科治疗。分别测两组绵羊术前和术后24 h、4周、8周的第1秒用力呼气容积(B超仅衔常规内科治疗,FEV1.0),且进行比较,A组定期行胸部CT检查,两组动物治疗8周均予以处死,行病理学检查。结果①成功复制绵羊肺气肿动物模型16只,A组术中、术后无明显异常;②A组胸部CT示术后4周及8周,在治疗区均出现肺容积缩小,出现肺不张表现;③两组不同时间点FEV1.0水平差异有显著性(F时间=1 352.409,P<0.001),两种治疗手段效果差异有显著性(F组间=5 004.278,P<0.001),治疗手段和时间之间有交互作用(F交互=1 325.058,P<0.001);④病理示A组治疗区见肺泡萎陷区,非治疗区域见肺气肿,肺泡萎陷区见粒细胞和淋巴细胞浸润;B组见肺气肿的肺泡组织。结论该技术治疗绵羊肺气肿模型具有有效性及优越性。

[Objective]To explore the effectiveness and superiority of establishing airway bypass through bronchoscopic radio frequency catheter lung volume reduction in the sheep model of pulmonary emphysema.[Methods] Sixteen female sheep aged 6 months were divided into group A and group B randomly and emphysema models were established by means of papain. Group A were set up airway bypass through bronchoscopic radio frequency catheter and given conventional medical treatment, group B were only given conventional medical treatment.（FEV1.0） of every sheep was measured and compared prior to treatment, 24 hours, 4 weeks and 8 weeks post treatment.Thoracic CT of group A was examined regularly. All sheep were executed at 8 weeks post treatment and were applied to pathological examination. [Results]① 16 sheep pulmonary emphysema model were established successfully. No obvious intraoperative and postoperative. abnormality were observed in group A ② Thoracic CT of group A at 4 weeks and 8 weeks after operation showed that lung volume of the treatment area shrinked and atelectasis appeared. ③Differences of disparate time points FEV1.0 levels were significant（F time=1 352.409, P 0.001）; Differences of the two therapies were significant（F group=5 004.278, P 0.001） and therapies and time were interactive（F time＊group=1 325.058, P 0.001）. ④Pathological examination showed that in group A, alveolar atelectatic area in treatment area and emphysema in non treatment area; granulocyte and lymphocyte infiltrated in alveolar atelectatic area were observed. Alveolar tissue emphysema was seen in group B. [Conclusion]Establishing the airway bypass through bronchoscopic radio frequency catheter lung volume reduction is effective and is superior to medical treatment in the sheep model of pulmonary emphysema.