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.

The use of a self-made airway occlude in bronchoscopic lung volume reduction

Objective To explore the therapeutic efficacy of a self-made occluder used for bronchoscopic lung volume reduction(BLVR).Methods Two patients with severe chronic obstructive pulmonary disease(COPD)in stable phase were selected for the present study.One or two nitinol occluders were placed,guided by brochoscopy,into the target bronchi of the two patients.Examination of pulmonary functions,chest computed tomography,complications,blood gas analysis,and evaluation of life quality with St George's respiratory questionnaire(SGRQ)were carried out before and 7 months after the bronchoscopic lung volume reduction.Results No dislodging or shifting of all the inserted occluders occurred.Only slight proliferation of granulation tissue was found in mucous membrane around the occluder,and atelectasis was observed at the target sites of lung.Before and 7 months after BLVR,ventilatory capacity(VC)of case 1 rose from 3.08L to 3.57L,and that of case 2 was elevated from 2.19L to 2.58L.Forced vital capacity(FVC)of case 1 was elevated from 2.87L to 3.57L,and that of case 2 from 2.60L to 2.58L.SGRQ showed a remarkable improvement of patients' dyspnea with a decrease of scores from 62 to 26 in case 1 and from 48 to 23 in case 2.No evident changes were found on arterial oxygen blood partial pressure(PaO2)in both patients,and no severe complications such as obstructive pneumonia or pneumothorax occurred yet in either case 1 or case 2.Conclusion The present study has demonstrated that the self-made occluder is convenient for insertion with satisfactory stability and therapeutic efficacy.Application of such occluder is safe with few complications,and may serve the purpose of reducing lung volume and improving lung function.