经纤维支气管镜肺减容术动物实验中的病理学观察

目的通过观察绵羊肺气肿模型经纤维支气管镜肺减容术(bronchoscopic lung volume reduction,BLVR)术后的病理学改变,验证自行研发单向活瓣支架的安全性及有效性。方法选正常成年雌性绵羊9只制成肺气肿模型,随机选择1只处死经病理证实肺气肿,另8只于靶叶肺段或亚段支气管开口处置入记忆金属单向活瓣支架,其中前3例未予抗炎治疗,另5例围手术期抗炎治疗。饲养8周后处死动物,观察其肺组织的病理学改变。结果前3例中1例有肺不张形成,另2例为阻塞性肺炎;其余5例均有肺不张形成,未发生阻塞性肺炎,其中2例肺组织形成纤维化瘢痕;全部实验动物均可见支气管黏膜上皮轻度损伤,黏膜下少量急慢性炎细胞浸润及少量纤维母细胞增生,未见新生肉芽组织及瘢痕。结论由该课题组自行研发的记忆金属单向活瓣支架有较好的组织相容性,对支气管黏膜损伤小,经抗炎治疗可保证活瓣的引流功能,活瓣远端肺组织可形成萎陷、实变、甚至纤维化,从而减少气肿肺的死腔面积,以达到肺减容的目的。

Pathologic features after bronchoscopic lung volume reduction in animal model of emphysema

Objective] To confirm the safety and effectivity of the self-made endo-bronchial one way valve according to study of the pathologic features of sheep model of emphysema after the bronchoscopic lung volume reduction(BLVR)procedure.Method] The self-made one way valves were placed in the target bronchium of the sheep of emphysema by using bronchoscope.After eight weeks autopsy was done and the pathologic features of the sheep were studied.Results] One atelectasis was observed in the three sheep without antibiotic therapy,obstructive pneumonia in the other two.Atelectasis was observed in all of the five sheep with antibiotic therapy.Fibrosis and scar was observed in two of the five sheep.The bronchial mucosa was tiny damnification in the all sheep.Conclusion] The self-made endo-bronchial one way valve with good histocompatibility can effectively reduce the lung volume and drinage the secretion.The antibiotic is necessary during the treatment.