选择性支气管单向活瓣置入术治疗老年难治性气胸3例伴文献复习

目的：观察经支气管镜下置入单向活瓣(EBV)行肺减容术(BLVR)治疗难治性气胸的临床效果及不良反应。方法2015年6月至12月我院呼吸科病房收治3例男性老年气胸患者,均为经胸腔闭式引流术治疗2周以上未愈者,胸腔引流管直径均≥16F。所有患者均在局部麻醉条件下接受支气管镜操作,采用 Chartis 肺旁路通气评估系统确定引起气胸的靶肺叶,并应用 EBV 治疗。结果3例患者分别置入2~5枚不同直径的 EBV,术后7~10 d 拔除引流管。结论 BLVR 治疗难治性气胸的作用机制与治疗非均质性肺气肿基本一致,在靶肺叶所属支气管内置入相应内径的 EBV,使胸腔内气体经 EBV 引流出来,同时又阻止气体随吸气动作通过支气管胸膜瘘口进入胸腔,进而促使瘘口逐渐愈合。BLVR 安全性高,不良反应较少,老年患者也可耐受,值得临床推荐。

Bronchoscopic lung volume reduction with one-way endobronchial valve in treatment of elderly refractory pneumothorax patients:three cases report

Objective To observe the clinical effect and adverse reactions of bronchoscopic lung volume reduction (BLVR) with Zephyr one-way endobronchial valve (EBV) in treatment of elderly refractory pneumothorax.Methods Three elderly male patients with refractory pneumothorax were enrolled.All these patients were treated with thoracic closed drainage for more than two weeks (chest drainage tube diameter ≥ 1 6F).Flexible bronchoscope examination was operated under the condition of topical anesthesia.The target lung lobes were assessed by Chartis system intraoperatively.Results 2-5 EBV was placed in lobar or segmental bronchi to completely isolate the target lung lobe respectively in three patients.Postoperatively,all patients survived and had no severe compliations,chest drainage tube was pulled up 7-10 days later.Conclusions BLVR with EBV can be operated in the elderly under the condition of topical anesthesia.Many advantages are found such as minimal trauma,simple operation and good safety.Chartis system is the good standard of evaluating collateral ventilation between target lung lobe and nearby lobe.