经支气管镜单向活瓣肺减容术10例一年疗效分析

Effect of bronchoscopic lung volume reduction with valves: one year follow-up of ten cases

目的探讨经支气管镜单向活瓣肺减容术的1年内疗效。方法回顾性分析2012-2015年广东省人民医院10例慢性阻塞性肺疾病(COPD)接受经支气管镜单向活瓣肺减容术患者(其中6例为Olympus多中心临床研究患者)的各项临床指标。患者术前和术后1、3、6、12个月分别行肺功能、6分钟步行距离(6MWD)、改良英国医学研究委员会呼吸困难量表(mMRC)评分、慢性阻塞性肺病评估测试(CAT)评分等检测,并对上述结果进行分析。结果10例患者中6例置入单向支气管内Spration活瓣,4例置入单向支气管内Zephyr活瓣。与术前相比,患者术后1、3、6、12个月第1秒用力呼气容积、第1秒用力呼气容积占预计值百分比、mMRC评分及6MWD均有明显改善,残气量占预计值百分比、CAT评分改善不明显。术后1年内,1例患者出现肺部感染;3例患者出现急性加重,其中1例急性加重1次,2例急性加重3次。观察期内,未见操作及活瓣相关死亡。结论对于选择性的重度肺气肿患者,经支气管镜单向活瓣肺减容术可改善患者的通气功能及活动耐量,但需进一步研究及观察其更长时间内的疗效及能否带来生存获益。

Objective To explore the effect of bronchoscopic one-way valve lung volume reduction on chronic obstructive lung disease(COPD)in one year after the procedure.Methods The clinical data of ten patients with COPD who underwent bronchoscopic one-way valve lung volume reduction in Guangdong Provincial People′s Hospital from 2012 to 2015 were retrospectively analyzed,including six patients in the Olympus multi-center clinical trial.The pulmonary function,6-minute walking distance(6MWD),modified British medical research council(mMRC)score and chronic obstructive pulmonary disease assessment test(CAT)score were measured before operation and in 1,3,6 and 12 months after operation,respectively,and the results were analyzed.Results Six of the ten patients were implanted with one-way intrabronchial Spration valve and four with one-way endobronchial Zephyr valve.Compared with pre-operation,forced expiratory volume in one second,percentage of forced expiratory volume in one second in predicted value,mMRC score and 6MWD of the patients were significantly improved in 1,3,6 and 12 months after operation,while percentage of residual volume in predicted value and CAT score were not significantly improved.Within one year after operation,one patient had pulmonary infection,three patients had acute exacerbation,in which one had acute exacerbation once,and two had acute exacerbation three times.During the observation period,there were no operative and valve-related deaths.Conclusions For patients with selective severe emphysema,bronchoscopic one-way valve lung volume reduction can improve ventilation function and activity tolerance,but further studies are needed to observe the long-term efficacy and survival benefits.