大型C臂机实时引导下经超细支气管镜肺大疱减容术初探

根据肺实质累及和过度通气的程度,肺大疱分3种亚型。Ⅰ型起于胸膜下或肺实质瘢痕附近,其颈部窄,易破裂,与有关肺综合征有很大关系。Ⅱ型以颈部宽、浅表为其特征,有血管和部分毁损的肺组织,被认为与自发性气胸最密切。     

大型C臂机实时引导下经超细支气管镜肺大疱减容术治疗效果分析

生物学肺减容术是指应用生物制剂引起受损肺部气肿（大疱）组织区域重塑和皱缩,减少已经或即将丧失功能肺组织的容积,从而提高残存肺功能,改善患者生存质量的治疗方法。我们总结了应用生物制剂在大型C臂机适时引导下经超细支气管镜行肺大疱减容术的7例临床资料,并进行了治疗效果分析,现报告如下。     

大型C臂机实时引导下经支气管镜针吸活组织检查术诊断孤立性肺结节初探

肺部外周结节的常见疾病主要有周围小肺癌、结核瘤及纤维干酪样结节、球型肺炎、机化性肺炎、肺部真菌感染、肺炎性假瘤、肺部其他良性肿瘤等。尽管大多数肺孤立性结节(SPN)细针经皮肺穿刺活组织检查(活检)即可作出正确的     

经纤维支气管镜肺减容术的研究进展

慢性阻塞性肺疾病(COPD)是一种以气流受限不完全可逆,进行性发展为特征的疾病。而肺气肿是COPD中重要的病变类型,即是远端终末细支气管,包括呼吸末细支气管、肺泡管、肺泡囊和肺泡,长期过度充气膨胀,使得终末小气道发生不可逆的损害,造成终末小气道的弹性严重减退。其传统治疗     

经支气管镜肺减容术治疗肺气肿的研究进展

肺气肿的治疗除了传统内科疗法和外科肺减容术,近来人们又设想经支气管镜进行处理,引起肺不张.以减少肺容积,从而达到治疗肺气肿的目的 .经过动物实验后镜下处理已经小范围应用于临床,主要有2种方法 .分别是在气道中放置单向活瓣装置和用生物胶栓塞支气管.他们均显示出有效性,但其远期疗效还需观察.     

经支气管镜肺减容术的实验研究

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,置人栓子共脱落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 该单向活瓣柃子的性能稳定,栓子町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.     

经支气管镜肺减容术的研究及其临床应用

经支气管镜肺减容术（ bronchoscopic lung volume reduction,BLVR） 是在不开胸的情况下达到肺减容的目的，以减少肺减容术后并发症，为终末期COPD患者的治疗提供新的方法。与外科肺减容术比较BLVR的创伤小、费用低、术后恢复时间短、并发症少，且可以调整置入活瓣的位置或取出。基于以上优点，严重肺气肿不能耐受手术的患者可以接受BLVR。笔者结合文献介绍BLVR的国内外研究和临床应用现状。     

经支气管镜单向活瓣肺减容术的分析及护理

<正>经支气管镜肺减容术(bronchoscopic lung volume reduction,BLVR)是根据肺减容的原理,通过支气管镜将单向活瓣置入到靶支气管内,使靶区的气体出多进少,以最终达到靶区肺不张或体积显著缩小的减容效果,从而减轻对相对正常肺区的压迫、使低平的膈肌部分恢复型态、增加收缩力。BLVR对慢性阻塞性肺疾病(chronic obstructive     

CT引导下序贯减容术治疗肺大疱的临床研究

目的探讨CT引导下经皮肺穿刺及序贯减容术治疗肺大疱的安全性及有效性。方法采用CT引导下经皮肺穿刺及序贯减容术治疗肺大疱患者25例,观察治疗前后血气分析、肺功能、胸部CT、呼吸困难分级评分变化(MMCR)、及手术的安全性。结果均顺利完成手术,手术时间15~30 min,平均25.7 min,无严重并发症。术后胸腔引流2~7 d,平均引流3.4 d,血气分析、肺功能指标、MMCR评分标准评分较术前改善明显,胸部CT检查提示重症肺大疱消失或较术前缩小至少大于50%,肺复张良好,生活质量明显提高。结论CT引导下经皮肺穿刺及序贯减容术治疗肺大疱操作方便、微创安全、疗效较好。尤其适用于心肺功能不全而不能耐受传统全麻开胸手术的重症肺大疱患者。     

经支气管镜肺减容术微创治疗COPD及其相关并发症的现况及展望

【】肺部疾病是威胁人类健康的重要疾病。传统肺减容术在治疗COPD、COPD相关肺大疱及术后持续性肺漏气等具有一定的局限性。经支气管镜肺减容术微创治疗是肺部疾病的新型治疗方式,具有理想的疗效和较少的并发症,已在COPD及肺大疱治疗领域得到推广。同时,经支气管镜肺减容术可以有效预防持续性肺漏气的产生,而且,对于术后出现的经支气管镜肺减容术,经支气管镜肺减容术或存在有待开发的治疗潜力。本综述旨在介绍经支气管镜肺减容术在多种COPD相关病症的治疗效果及进展。     

肺减容术治疗肺气肿机制的研究进展

肺减容术（lung volume reduction surgery，LVRS）治疗重度肺气肿取得显著效果，本文介绍了其作用机制的研究进展，包括肺弹性回缩力增加及膈肌的收缩效能的提高等，为改良手术方式、提高手术疗效、选择合适的患者提供依据。     

肺减容术治疗慢性阻塞性肺气肿疗效的临床观察

目的探讨肺减容术(LVRS)对慢性阻塞性肺气肿(COPE)患者的疗效。方法 23例该类患者用直线切缝器切除肺边缘20%～25%弥漫性大泡肺组织,常规用3/0prolene缝线连续往返缝合,必要时3/0prolene缝线加毛毡垫片行褥式缝合。结果本组共23例,采用LVRS治疗,无1例死亡,发生肺泡漏气者等并发症5例(21.7%)。23例中有17例随访,自觉症状均不同程度改善。结论 LVRS对于COPE患者,特别是合并多发性肺大泡患者的近期治疗效果明显,但远期效果仍有待进一步观察。该方法简单易行,易于基层医院推广。     

同期肺减容术治疗食管癌合并重度肺气肿

目的 分析同期肺减容术（LVRS）治疗食管癌合并重度肺气肿的临床疗效.方法 选取31例食管癌合并重度肺气肿患者,行食管癌根治术的同时行一侧LVRS,观察术后患者机械通气状况,自身对照术前动脉血气、肺功能等指标,判断术后的临床疗效.结果 所有患者均顺利渡过围术期,无严重的呼吸衰竭和心脏等并发症,呼吸症状、肺功能和动脉血气各项指标明显改善,6 min步行距离显著延长.结论 LVRS为部分食管癌合并重度肺气肿合患者提供了新的治疗方法,术后改善了肺功能,提高了患者生活质量.     

经支气管镜活瓣植入肺减容术治疗重度肺气肿36例疗效观察

目的 研究经支气管镜活瓣(EBV)植入肺减容术治疗重度肺气肿的疗效.方法 回顾性分析从2016年10月～2019年2月,于我院实施EBV植入肺减容术治疗的36例重度肺气肿患者的相关病历资料,记为研究组.另取从2013年2月～2015年6月,于我院接受开胸肺减容术治疗的36例重度肺气肿患者作为对照组.比较治疗前后两组肺功...     

重度阻塞性肺气肿肺减容手术后运动能力及生活质量的 …

目的对重度阻塞性肺气肿患者肺减容手术（ＬＶＲＳ）后呼吸困难指数,运动能力、生活质量进行评价,方法采用体容积描记仪、运动心肺功能仪对１０例患者术前及术后３、６、１２个月肺功能,运动心肺功能及６分钟步行距离（６ＭＷＤ）进行测定。并用简易医学研究委员会呼吸困难评分标准及诺丁汉姆健康状况标准（ＮＨＰ）对呼吸困难程度及生活质量进行评价。结果术后３、６、１２个月与术前相比,用力肺活量（ＦＶＣ）、一秒钟用力呼气     

Lung volume reduction surgery in lieu of pneumonectomy in an infant with severe unilateral pulmonary interstitial emphysema

A male infant with a prenatal diagnosis (at 20 weeks' gestation) of cystic adenomatoid malformation was delivered after 38 weeks' gestation (birth weight, 3 kg) and admitted to the neonatal intensive care unit. During the first few days of life, he developed mild respiratory distress; a chest radiograph and computed tomography scan showed multiple cystic areas in the left lower lobe with hyperinflation and herniation of the upper lobe across the midline. At 3 weeks of age, a left lower lobectomy was performed for presumed cystic malformation. To our surprise the pathology reports revealed pulmonary interstitial emphysema. The postoperative chest radiograph was unchanged, and mechanical ventilation was necessary and required progressively increasing ventilatory settings to provide adequate support. High-frequency oscillatory ventilation and selective right bronchus intubation failed to improve lung function. After 3 weeks, a left thoracotomy was repeated and lung volume reduction was performed with removal of 50' of the peripheral hyperinflated parenchyma. Postoperative recovery was rapid; the child was weaned from the ventilator after 3 days and discharged after 3 weeks. Follow-up chest X-rays showed a normally expanded right lung with mediastinal structures back to midline and a small left lung. Favorable results persisted at 3 years of follow-up. This first and successful experience with lung volume reduction in a neonate suggests that infants who need removal of a large portion of lung parenchyma to achieve adequate ventilation and gas exchange, lung volume reduction surgery should be considered as an alternative to pneumonectomy.     

Veno-venous extracorporeal membrane oxygenation support during lung volume reduction surgery for a severe respiratory failure patient with emphysema

The use of extracorporeal membrane oxygenation (ECMO) in adults has increased in popularity and importance for the support of patients with cardiac or pulmonary failure, but rarely been described as a means of support during anaesthesia and surgery. We report the case of a patient who required lung volume reduction because of emphysema where veno-venous ECMO was required both during surgery and for the first four days postoperatively. We describe the anaesthetic management of this patient who had severe respiratory failure, review other alternatives and discuss why ECMO was particularly suited to this case.     

Application of lung volume reduction surgery for a child with filamin A (FLNA) mutations

Diffuse lung disease in early childhood due to mutations in the filamin A gene has been recently reported. Clinical outcomes vary among individuals indicating variability in phenotype but a substantial proportion of reported cases in early life have ended up in death or lung transplantation. We recently encountered a school-aged child in whom the diagnosis of a filamin A mutation was delayed and the natural history of emphysematous lung disease was altered by serial lung volume reduction surgeries. She eventually underwent a bilateral lung transplant and we report the natural history of her disease and treatments applied herein.     

Improved activities of daily living, psychological state and health-related quality of life for 12 months following lung volume reduction surgery in patients with severe emphysema

OBJECTIVE: The aim of the present study was to evaluate the effect of lung volume reduction surgery (LVRS), with an emphasis on improvement in activities of daily living (ADL), psychological state and health-related quality of life (HRQL), for 12 months in patients with severe emphysema. METHODOLOGY: Eighteen male patients (mean age +/- SD: 65.2 +/- 6.4 years) who underwent LVRS following pulmonary rehabilitation (LVRS group) and 12 patients (67.0 +/- 8.1 years) who were medicated and underwent pulmonary rehabilitation (non-LVRS group) were studied. LVRS was performed by video-assisted thoracoscopic surgery. Serial measurements of lung function, 6-min walking distance (6MWD), ADL, HRQL and psychological state scores were performed before surgery and 3, 6, and 12 months after surgery (in the LVRS group), or on the day of discharge (in the non-LVRS group). RESULTS: As well as an improvement in FEV(1) and 6MWD, ADL scores were significantly improved in the items of 'face washing and teeth brushing', and 'indoor walking' at 3 months after LVRS (P < 0.05). At 12 months, an improvement was still found in 'indoor walking' and 'bathing'. HRQL scores were ameliorated at 3-12 months after LVRS. In the non-LVRS group, ADL and HRQL scores failed to improve in any items during the 12 months of observation. Psychological state scores were maintained in the LVRS group and were better than those in the non-LVRS group at 12 months (P < 0.05). CONCLUSIONS: Lung volume reduction surgery improves not only lung function and exercise performance but also ADL, HRQL and psychological state for at least 12 months.