纤维支气管镜肺减容术治疗绵羊肺气肿模型的实验研究

Treatment of pulmonary emphysema sheep model through bronchoscopic lung volume reduction:an experimental study

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月龄雌性绵羊随机分为A、B 2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,2组均给予内科治疗。分别测2组绵羊术前和术后24 h、4、8周的第1秒用力呼气容积(forced expiratory volume in one second,FEV1.0),且进行比较,A组定期行胸部CT检查,2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、术后无并发症出现;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;32组不同时间点FEV1.0水平差异有统计学意义(F时间=1 352.409,P=0.000),2种治疗手段效果差异有统计学意义(F组间=5 004.278,P=0.000),治疗手段和时间之间有交互作用(F交互=1 325.058,P=0.000);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 set up airway bypass through bronchoscopic radio frequency catheter. Both groups were given medical treatment. Forced expiratory volume in one second（FEV1.0）of every sheep before the treatment,24 h,4 weeks and 8 weeks after the treatment were measured and compared. Thoracic CT of group A was examined regularly. All sheep were executed at 8 weeks after the treatment and were applied to do pathological examination. Results：1sixteen sheep were copied into pulmonary emphysema model successfully. No obvious intraoperative and postoperative abnormality was observed in group A. 2Thoracic CT of group A at 4 weeks and 8 weeks after the operation showed that：lung volume of the treatment area shrinked and atelectasis appeared. 3FEV1.0levels at different time points were significantly different（Ftime=1 352.409,P=0.000）;treatment effects of two therapies were significantly different（Fgroup=5 004.278,P=0.000）,and therapies and time were interactive（Ftime×group=1 325.058,P=0.000）. 4Pathological examination showed that：in group A,alveolar atelectatic area was seen in treatment area and emphysema in non treatment area;granulocyte and lymphocyte infiltrated in alveolar atelectasis. 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.