支气管镜肺减容术的研究现状

经支气管镜肺减容术(BLVR)是基于肺减容术(LVRS)治疗肺气肿的理论,目前仍处于实验和临床试用阶段,许多问题还有待阐明。BLVR的治疗机制主要包括肺萎陷、局灶性纤维化、通气血流再分布、呼吸力学优化等。对手术靶区的选择,目前基本上限于上叶或者病变破坏严重的肺段。手术方法应用较多的是经支气管镜向靶区引流支气管放置单向阀。临床效果,近期疗效尚满意。     

肺气肿肺减容术对同侧和对侧肺叶的影响

摘要目的研究肺减容术治疗肺气肿对同侧和对侧肺叶的容积及密度产生的影响。方法本研究包括经支气管镜肺减容术的289例不均匀性肺气肿病人以及132例未经治疗的对照组病人,根据CT图像评估肺叶的容积和透亮度的改变。采用回归分析(Spearman’sρ)观察病变肺叶容积与其他肺叶容积和密度变化的相关性。     

重视介入性肺减容术的研究

介入性肺减容术是在外科切除肺减容术和内镜下非外科切除肺减容术的基础上发展起来的。它是一项X线导引下的经导管治疗技术,在靶肺叶经支气管行博来霉素(或无水乙醇)碘油乳剂栓塞的同时并对其近端支气管用骨水泥封堵,可获得稳定的肺纤维化和肺减容,即所谓的功能性肺叶切除。虽然此项介入治疗技术目前仍处于动物实验阶段,但已经显露出其临床应用潜力和广阔的前景。     

肺减容术治疗慢性阻塞性肺气肿的应用进展

本文综合近五年国内外关于肺减容术治疗慢阻肺方面的文献资料，资料显示肺减容术是目前治疗慢阻肺的有效手段，有多种方法且逐渐向微创手术发展，特别是纤支镜肺减容术有很好的发展前景。     

气道内金属支架置入术联合放射性粒子植入对比放疗治疗肺癌气道狭窄的临床研究

目的 比较气道内金属支架置入术联合应用放射性粒子与气道内金属支架置入术联合放疗治疗肺癌患者气道狭窄的疗效及不良反应.方法 将46例肺癌患者分为两组,治疗组和对照组各23例.治疗组采用气道内金属支架置入术联合应用放射性粒子,对照组采用气道内金属支架置入术联合放疗.观察两组6个月、1年、2年生存率,呼吸困难间隔时间,肿瘤体积缩小比例,2年内患者气管镜治疗次数及住院天数等疗效;以及治疗后发生消化道反应、白细胞减少等不良反应.结果 两组患者6个月生存率无显著差异,治疗组患者1年生存率、2年生存率高于对照组.治疗组患者肿瘤体积缩小比例、再发呼吸困难间隔时间长于对照组.2年内治疗组患者气管镜治疗次数及住院天数少于对照组.结论 气道内金属支架置入术联合局部放射性粒子植入治疗肺癌气道狭窄的疗效优于气道内金属支架置入术联合放疗.     

外科术后急性肺血栓栓塞症的介入治疗疗效

目的 探讨介入技术在治疗外科术后急性肺血栓栓塞中的临床疗效.方法 对11例外科术后急性肺血栓栓塞患者实施下腔静脉滤器植入术和经导管肺动脉取栓、溶栓治疗.结果 11例患者下腔静脉滤器均成功植入,介入治疗后临床症状明显改善,无严重并发症发生.结论 下腔静脉滤器植入和经导管肺动脉取栓、溶栓术治疗外科术后急性肺血栓栓塞安全微创,效果立竿见影.     

微创非切除法肺减容术的研究进展

微创治疗是肺减容术(LVRS)治疗重度肺气肿的发展方向,随着新方法和新器械的不断出现及改进,这种治疗将成为重度肺气肿病人的另一个重要选择。该文回顾了目前肺气肿治疗的概况,就微创肺减容术的方法、器械以及初步研究成果和最新进展等进行了综述。     

气道金属支架治疗支气管结核伴全肺不张9例

目的评价气道内金属支架植入治疗支气管结核伴一侧全肺不张的疗效及安全性。方法对9例因支气管结核引起支气管管腔完全闭塞、一侧全肺不张患者,采用微波、高频电、球囊扩张加气道内金属支架植入治疗,分别在支架植入后1周及4～6个月期间观察患者气道狭窄段的腔径。结果9例支气管结核患者于支架植入后3d内,原先不张的患肺均完全复张;在支架植入7d后,原闭塞支气管的腔径恢复至(9.17±1.24)mm:9例患者中有3例出现了不同程度的肉芽增殖再狭窄,采用腔内冷冻治疗,同时配合定期的球囊扩张,可有效控制再狭窄。结论对于支气管结核所致的一侧全肺不张患者,与传统外科手术相比,腔内金属支架植入疗法可以有效地保护患者的肺功能,是有效、安全、微创的治疗方法。     

气管内金属支架植入在肺癌治疗中的应用

目的探讨金属支架治疗肺癌导致的气管狭窄的临床疗效。方法对16例肺癌压迫或侵犯气管引起的气管狭窄的患者,在纤维支气管镜的配合下,植入钛合金支架。结果所有病例支架植入后呼吸困难即刻好转,随后观察3～26个月,8例经放、化疗后仍存活,无呼吸困难及支架移位。结论金属支架植入术能缓解肺癌晚期引起的呼吸困难,改善生活质量。     

自制气道封堵器在经支气管镜肺减容术中的应用

目的 探讨自制内塞式支气管封堵器在经支气管镜肺减容术(BLVR)中的应用效果.方法 选择2例稳定期重度慢性阻塞性肺疾病(COPD)患者,在支气管镜引导下于靶位支气管置入1或2枚自制的镍钛合金封堵器,比较患者术前、术后7个月的肺功能、动脉血气、圣·乔治呼吸疾病问卷(SGRQ)、胸部CT及并发症等指标的差异,评价BLVR的疗效.结果 置入的封堵器无一脱落或移位;局部黏膜仅见轻度肉芽组织增生;被封堵的靶位肺组织出现不张或膨胀不全.术前和术后7个月,病例1、2的静态肺容积(VC)分别从3.08L上升至3.57L,2.19L上升至2.58L;用力肺活量(FVC)分别从2.87L上升至3.57L,2.60L上升至2.58L;SGRQ调查显示患者的呼吸困难症状显著改善,分值分别从62降低至26,48降低至23;但动脉氧分压提高均不明显.2例患者均未发生阻塞性肺炎、气胸等严重并发症.结论 本课题组自行研制的封堵器在两例重度COPD患者中初步应用已显示出其置入简便、稳定性好、封堵效果确实、并发症少的优点,能够达到肺减容及改善肺功能的目的.     

Covered Bronchial Stent Insertion to Manage Airway Obstruction with Hemoptysis Caused by Lung Cancer

Malignant airway obstruction and hemoptysis are common in lung cancer patients. Recently, airway stent is commonly used to preserve airway in malignant airway obstruction. Hemoptysis can be managed through various methods including conservative treatment, endobronchial tamponade, bronchoscopic intervention, embolization and surgery. In our case studies, we sought to investigate the effectiveness of airway stents for re-opening the airway as well as tamponade effects in four patients with malignant airway obstruction and bleeding caused by tumors or lymph node invasions.     

金属支架治疗恶性肿瘤引起的气管狭窄（附30例分析）

目的 评价金属支架治疗肺癌、食管癌等恶笥肿瘤引起的气管狭窄的可行性和疗效。方法 ３０例肺癌、管癌等恶性肿瘤压迫或侵犯气管，引起气管狭窄和严重的呼吸困难，分别置入自扩型金属支架。１１例患者进行了后续的化学治疗和放射治疗。结果 ３０例狭窄都位于主气管，共置入支架３０个（１２个ＧｉａｎｔｕｒｃｏＺ形支架，８个Ｗａｌｌｓｔｅｎｔ支架１０个Ｕｌｔｒａｆｌｅｘ支架）。所有患者呼吸困难得到立即缓解。１例杖后５６     

Treatment of Benign Tracheal Stenosis Utilizing Self-Expanding Nitinol Stents

We assessed the results of self-expanding metallic stent insertion into benign proximal tracheal stenosis in patients not appropriate or unfit for surgical repair. Proximal benign tracheal stenoses had occurred in 11 patients (7 men, 4 women, mean age 68.8 years) after long-time intubation (n = 6), tracheostomy (n = 4), or chondropathia (n = 1). Fourteen self-expanding nitinol stents were placed in the patients under general anesthesia with endoscopical and fluoroscopical guidance. Stent insertion was successful in all cases and led to immediate relief of the morphological and functional airway obstruction. No immediate complications were noted. During the mean follow-up period of 67.5 weeks we observed one recurrent dyspnea 3 months after implantation and granuloma formation at the stent insertion site in another patient. Both complications were successfully treated with additional stent insertion in one case and laser resection of granulomas in the other. Self-expanding nitinol stents should be considered for the treatment of benign proximal tracheal obstruction in selected patients for whom surgical repair is contraindicated.     

Outcomes of Metallic Biliary Stent Insertion in Patients with Malignant Bilobar Obstruction

PurposeTo assess clinical outcomes of metal stent insertion in patients with bilobar bile duct obstruction by malignant tumors.Materials and MethodsRecords of 120 consecutive patients who underwent placement of metallic stents for palliation of malignant bilobar biliary obstruction between 1995 and 2010 were retrospectively reviewed. Single-duct stent insertion was performed in 44 patients with one liver lobe that accounted for more than 70% of total liver volume or only one patent lobar portal vein (group 1). Bilobar stent insertion was performed in 60 patients with approximately equal lobe sizes, patent lobar portal veins, or cholangitis at presentation (group 2). In 16 patients with discontiguous right anterior and posterior segmental ducts (group 3), three stents were deployed in the left lobar and right anterior and posterior segmental ducts. Overall survival, primary patency, and patient morbidity rates following stent insertion were assessed.ResultsNo significant differences in mean overall survival (group 1, 7.3 mo; group 2, 10.3 mo; group 3, 6.5 mo; P = .21) or mean primary stent patency (group 1, 4.2 mo; group 2, 5.9 mo; group 3, 3.5 mo; P = .17) were demonstrated. However, patients in group 3 were significantly more likely to require hospitalizations for cholangitis and additional invasive procedures for recurrent biliary obstruction than patients in groups 1 and 2.ConclusionsUnilobar and bilobar metal stent insertion led to similar outcomes when treatment decision was based on relative liver lobe volumes, lobar portal vein patency, and presence of cholangitis on presentation.     

Role of the gianturco expandable metal stent in the management of tracheobronchial obstruction

This paper reports our experience in treating localized airway obstruction with expandable metal stents. Nine patients were treated for malignant obstruction and 6 for benign obstruction. The main indications for treatment were imminent asphyxia, breathlessness and/or repeated chest infections. All but 2 patients had received other treatments before referral. Seven patients with malignant obstruction had extrinsically compressed airways and all derived a sustained symptomatic improvement. Two patients with recurrent tracheal obstruction caused by intraluminal tumor gained lasting relief with the use of a covered expandable metal stent. All 6 patients with benign strictures were improved, although 2 developed recurrent obstruction caused by granulation tissue growing within, and beyond the stent. It is concluded that the expandable metal stent provides an effective and noninvasive method of relieving large airway obstruction. As the long-term tissue tolerance to this type of stent is not known, caution is advised in the management of benign strictures. In patients with malignant obstruction, however, the expandable metal stent would appear to have considerable potential as a palliative treatment.     

Combination Therapy of Temporary Tracheal Stenting and Radiofrequency Ablation for Multinodular Thyroid Goiter with Airway Compression

We report a case of multinodular thyroid goiter in an 80-year-old man who successfully underwent tracheal stent placement for respiratory distress caused by the thyroid goiter and following two radiofrequency (RF) ablation sessions performed for thyroid volume reduction. This sequential treatment allowed elective stent removals four weeks after the second RF ablation session because the thyroid volume had been progressively reduced. Combination therapy of temporary airway stenting and RF ablation for the treatment of thyroid goiter has two advantages, i.e., immediate reliefs of dyspnea with airway stenting and reductions of the thyroid volume with RF ablation, and thus, allowing symptom reliefs even after the stent removals.     

A Spanner in the works: the use of a new temporary urethral stent to relieve bladder outflow obstruction after prostate brachytherapy

PURPOSE: Assessment of the Spanner, a new temporary urethral stent to relieve bladder outflow obstruction and urinary symptoms after brachytherapy. METHODS AND MATERIALS: Five patients with unusually severe urinary morbidity after (125)I brachytherapy were recruited. The mean time after implant was 40 days (range 25-90). Spanner intraprostatic stents were introduced using topical anesthetic without complication. RESULTS: All patients were able to void spontaneously with no post-void residual volume of urine. The flow rates increased in all cases (p=0.03) and the International Prostate Symptom Scores were significantly improved after stent insertion in all patients (p=0.03). All patients experienced some degree of pain or dysuria during stent use. CONCLUSIONS: Bladder outflow obstruction was effectively treated with the Spanner intraprostatic stent, however pain limited the use of the device in the early post-brachytherapy patient group. Pharmacotherapy, stent design modification, or smaller stent diameter may increase the utility of stents after brachytherapy.     

Benign tracheobronchial stenoses: changes in short-term and long-term pulmonary function testing after expandable metallic stent placement

PURPOSE: To determine the short- and long-term improvement in airflow dynamics in patients undergoing tracheobronchial stent placement for benign airway stenoses. METHODS: Twenty-two patients underwent 34 tracheal and/or bronchial stent placement procedures for benign airway stenoses and had the results of pulmonary function tests available. Stent placement indications included bronchomalacia after lung transplantation (n = 11), postintubation stenoses (n = 6), relapsing polychondritis (n = 2), and 1 each of tracheomalacia, tracheal compression, and histoplasmosis. Six patients underwent more than one stent placement procedure (range: 2-7 procedures). The mean forced expiratory volume in one second (FEV(1) ), forced expiratory flow rate in the midportion of the forced vital capacity curve (FEF(25-75) ), forced vital capacity, and peak flow (PF) rate obtained before stent placement were compared with those immediately after stent placement and with those measurements most remote from stent placement using the paired two-tailed test. RESULTS: All patients reported improved respiratory function immediately after stent placement. The mean FEV(1), FEF(25-75), and PF rate improved significantly (p < 0.001, p = 0.002, and p = 0.009, respectively) after stent placement. On long-term follow-up averaging 15 months after stent placement, these parameters declined despite patients' subjective sense of improvement. Segregating the population into transplant and nontransplant airway stenosis etiologies, however, FEF(25-75) and PF rate remained significantly improved (p = 0.045, p = 0.027, respectively), over the long term for the latter. FEV increased after subsequent stent placements for patients receiving multiple stents. CONCLUSION: Stent placement for benign tracheobronchial stenoses provides significant immediate improvement in airflow dynamics. Long-term improvement in airflow obstruction may be expected, and additional stent placements may further improve pulmonary function.     

Chest radiographic findings following video-assisted thoracoscopic lung volume reduction surgery for emphysema

Surgical reduction of lung volume is being investigated as a promising alternative in the treatment of selected patients with severe debilitating emphysema. Following bilateral video-assisted thoracoscopic surgical resection (VATS) of emphysematous lung tissue, patients show improvements in exercise tolerance, dyspnoea, increases in oxygenation, decreased airway obstruction and enhanced quality of life. The postoperative findings in the first 24 patients who underwent bilateral VATS volume reduction are described. Pneumothoraces developed in all patients, often with unusual shapes related to the surgical sutures. Perihilar, pulmonary and paramediastinal pulmonary parenchymal opacities were seen in approximately half of the patients, representing areas of pulmonary contusion, atelectasis and/or haemorrhage associated with the staple lines. The purpose of the present study is to describe the immediate postoperative chest radiographic appearances and to familiarize radiologists with the surgical procedure.     

COPD患者肺气肿程度对气道径线与肺功能相关性的影响

目的：定量分析肺气肿程度对气道径线及其与肺功能相关性的影响。方法对73例慢性阻塞性肺疾病(COPD)患者行呼气相 CT 扫描,测量肺气肿指数(LAA%)以及右肺上叶尖段(RB1)、右肺下叶后基底段(RB10)、左肺上叶尖后段(LB1)、左肺下叶后基底段(LB10)亚段支气管的气道径线,包括管壁厚度(WT),管壁厚度/气道直径(WT/AD),管壁面积比值(WA%);以 LAA%=15%为界限,将 COPD 患者分为2组,即轻度肺气肿组(34例)和重度肺气肿组(39例)。分别比较不同亚段支气管的轻度、重度肺气肿组 WA%、WT/AD、WT 与 FEV1%的相关性。结果除外 RB10亚段支气管的轻度肺气肿组中 WT 及重度肺气肿组的气道径线与 FEV1%无明显相关(P >0.05),其余各亚段支气管(RB1,LB1,LB10)的轻度肺气肿组气道径线指标与 FEV1%均呈负相关(r=-0.382~-0.799,P <0.05),均优于重度肺气肿组(r =-0.371~-0.687,P <0.05)。RB1、LB1、LB10气道径线均与FEV1%呈负相关,其中 RB1的气道径线与 FEV1%相关性最好;各亚段支气管中轻度肺气肿组气道径线与 FEV1%的相关性均优于重度肺气肿组。结论肺气肿的严重程度会影响气道径线与气流受限的相关性,在 COPD 患者的 CT 定量研究中,需将这一相互影响的过程考虑入内。