The Progress of Bronchoscopic Lung Volume Reduction in Treating COPD_Chinese Journal of Respiratory and Critical Care Medicine

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WANG Guoan , WU Hongcheng

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COPD是以氣流受限不完全可逆為特征,可伴有肺組織破壞導致其彈性回縮力減低和肺過度膨脹,呈進行性發展的一種疾病。OPD的總患病率為6%,其中肺氣腫患病率為1.8%,是美國疾病死亡的第四大原因,而且每年呈現上升趨勢,給全球社會和經濟帶來嚴重負擔,嚴重威脅人類健康。內科保守治療能減輕患者病情,但對病情進程的影響還有待進一步研究。外科肺減容術(LVRS)通過切除嚴重肺氣腫組織可恢復肺的彈性回縮力,使鄰近相對正常肺組織擴張,在呼氣時維持氣道擴張,使氣道阻力下降;使肺容積縮小,肺的順應性增加,減少無效腔,改善肺的彌散功能;恢復肺、胸廓以及膈肌的彈性,緩解壓迫,有利于減少肺心血管阻力及右心負荷,改善右心功能。美國肺氣腫國家試驗研究(NETT)結果肯定了LVRS方法的有效性,但適應證僅限于上葉病變、活動受限的非均質性肺氣腫患者,而且創傷大,并發癥多,風險高。于是便催生了經支氣管鏡肺減容術(BLVR)這一新技術,其主要思路有:放置支氣管內單向活瓣或氣道內塞裝置使其靶肺不張;注入生物膠粘劑使過度充氣肺組織萎陷、重構及人工氣道旁路增加呼出氣量。本文就近年來國內外BLVR的研究現狀和進展綜述如下。

Citation： WANG Guoan,WU Hongcheng. The Progress of Bronchoscopic Lung Volume Reduction in Treating COPD. Chinese Journal of Respiratory and Critical Care Medicine, 2009, 09(3): 309-311. doi: Copy

1.	Ambrosino N, Simonds A. The clinical management in extremely severe COPD. Respir Med, 2007, 101: 1613-1624.
2.	Camp PC, Sugarbaker DJ. Surgical interventions for emphysema.Semin Thorac Cardiovasc Surg, 2007, 19: 157-171.
3.	Halbert RJ, Natoli JL, Gano A, et al. Global burden of COPD:systematic review and meta-analysis. Eur Respir J, 2006 , 28: 523 -532.
4.	Koizumi K, Haraguchi S, Akiyama H, et al. Comparison of changes in hemodynamics between unilateral and bilateral lung volume reduction for pulmonary emphysema. Ann Thorac Cardiovasc Surg,2001, 7: 266-272.
5.	沈利明, 周大勇, 沈均康, 等. 螺圈加膠水法封堵兔肺支氣管的實驗研究. 介入放射學雜志, 2006, 15: 32-35.
6.	Chang AC, Chan KM, Martinez FJ. Lessons from the national emphysema treatment trial. Semin Thorac Cardiovasc Surg, 2007 ,19: 172-180.
7.	Fishman A, Martinez F, Naunheim K, et al. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. N Engl J Med, 2003, 348: 2059-2073.
8.	Sabanathan S, Richardson J, Pieri-Davies S. Bronchoscopic lung volume reduction. J Cardiovasc Surg, 2003, 44: 101-108.
9.	Toma TP, Matsuo K, Tomaoki A, et al. Endoscopic bronchial occlusion with spigots in patients with emphysema. AmJ Respir Crit Care Med, 2002, 165( Suppl) : B9.
10.	Snell GI, Holsworth L, Borrill ZL, et al. The potential for bronchoscopic lung volume reduction using bronchial prostheses: a pilot study. Chest, 2003, 124: 1073-1080.
11.	Toma TP, Hopkinson NS, Hillier J, et al. Bronchoscopic volume reduction with valve implants in patients with severe emphysema.Lancet, 2003, 361: 931-933.
12.	Hopkinson NS, Toma TP, Hansell DM, et al. Effect of bronchoscopic lung volume reduction on dynamic hyperinflation and exercise in emphysema. Am J Respir Crit Care Med, 2005, 171: 453-460.
13.	Wan IY, Toma TP, Geddes DM, et al. Bronchoscopic lung volume reduction for end-stage emphysema: report on the first 98 patients.Chest, 2006, 129: 518-526.
14.	de Oliveira HG, Macedo-Neto AV, John AB, et al.Transbronchoscopic pulmonary emphysema treatment: 1-month to 24-month endoscopic follow-up. Chest, 2006, 130: 190-199.
15.	Crespo MM, Johnson BA, McCurry KR, et al. Use of endobronchial valves for native lung hyperinflation associated with respiratory failure in a single-lung transplant recipient for emphysema. Chest,2007, 131: 214-216.
16.	Strange C, Herth FJ, Kovitz KL, et al. Design of the Endobronchial Valve for Emphysema Palliation Trial ( VENT) : a non-surgical method of lung volume reduction. BMC Pulm Med, 2007, 7: 10.
17.	沈寧, 姚婉貞, 郝振婷, 等. 經支氣管鏡肺減容術初探. 中國呼吸與危重監護雜志, 2006, 5: 31-34.
18.	王萍, 王瑞娟, 霍秀青, 等. 經支氣管鏡肺減容術一例報告. 中國呼吸與危重監護雜志, 2006, 5: 202-203.
19.	Ingenito EP, Reilly JJ, Mentzer SJ, et al. Bronchoscopic volume reduction: a safe and effective alternative to surgical therapy for emphysema. Am J Respir Crit Care Med, 2001, 164: 295-301.
20.	Ingenito EP, Berger RL, Henderson AC, et al. Bronchoscopic lung volume reduction using tissue engineering principles. Am J Respir Crit Care Med, 2003, 167: 771-778.
21.	Reilly J, Washko G, Pinto-Plata V, et al. Biological lung volume reduction: a new bronchoscopic therapy for advanced emphysema.Chest, 2007, 131: 1108-1113.
22.	王萬勝, 朱赤, 張德志, 等. 平陽霉素碘油乳劑栓塞肺減容術的初步研究. 介入放射學雜志, 2006, 15: 36-40.
23.	楊和平, 戴曉天, 王海晶, 等. 經纖支鏡行肺減容術機制初步探討. 重慶醫學, 2008, 37: 119-121.
24.	Lausberg HF, Chino K, Patterson GA, et al. Bronchial fenestration improves expiratory flow in emphysematous human lungs. Ann Thorac Surg, 2003, 75: 393-397.
25.	Rendina EA, De Giacomo T, Venta F, et al. Feasibility and safety of the airway bypass procedure for patients with emphysema. J Thorac Cardiovasc Surg, 2003, 125: 1294-1299.

1. Ambrosino N, Simonds A. The clinical management in extremely severe COPD. Respir Med, 2007, 101: 1613-1624.
2. Camp PC, Sugarbaker DJ. Surgical interventions for emphysema.Semin Thorac Cardiovasc Surg, 2007, 19: 157-171.
3. Halbert RJ, Natoli JL, Gano A, et al. Global burden of COPD:systematic review and meta-analysis. Eur Respir J, 2006 , 28: 523 -532.
4. Koizumi K, Haraguchi S, Akiyama H, et al. Comparison of changes in hemodynamics between unilateral and bilateral lung volume reduction for pulmonary emphysema. Ann Thorac Cardiovasc Surg,2001, 7: 266-272.
5. 沈利明, 周大勇, 沈均康, 等. 螺圈加膠水法封堵兔肺支氣管的實驗研究. 介入放射學雜志, 2006, 15: 32-35.
6. Chang AC, Chan KM, Martinez FJ. Lessons from the national emphysema treatment trial. Semin Thorac Cardiovasc Surg, 2007 ,19: 172-180.
7. Fishman A, Martinez F, Naunheim K, et al. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. N Engl J Med, 2003, 348: 2059-2073.
8. Sabanathan S, Richardson J, Pieri-Davies S. Bronchoscopic lung volume reduction. J Cardiovasc Surg, 2003, 44: 101-108.
9. Toma TP, Matsuo K, Tomaoki A, et al. Endoscopic bronchial occlusion with spigots in patients with emphysema. AmJ Respir Crit Care Med, 2002, 165( Suppl) : B9.
10. Snell GI, Holsworth L, Borrill ZL, et al. The potential for bronchoscopic lung volume reduction using bronchial prostheses: a pilot study. Chest, 2003, 124: 1073-1080.
11. Toma TP, Hopkinson NS, Hillier J, et al. Bronchoscopic volume reduction with valve implants in patients with severe emphysema.Lancet, 2003, 361: 931-933.
12. Hopkinson NS, Toma TP, Hansell DM, et al. Effect of bronchoscopic lung volume reduction on dynamic hyperinflation and exercise in emphysema. Am J Respir Crit Care Med, 2005, 171: 453-460.
13. Wan IY, Toma TP, Geddes DM, et al. Bronchoscopic lung volume reduction for end-stage emphysema: report on the first 98 patients.Chest, 2006, 129: 518-526.
14. de Oliveira HG, Macedo-Neto AV, John AB, et al.Transbronchoscopic pulmonary emphysema treatment: 1-month to 24-month endoscopic follow-up. Chest, 2006, 130: 190-199.
15. Crespo MM, Johnson BA, McCurry KR, et al. Use of endobronchial valves for native lung hyperinflation associated with respiratory failure in a single-lung transplant recipient for emphysema. Chest,2007, 131: 214-216.
16. Strange C, Herth FJ, Kovitz KL, et al. Design of the Endobronchial Valve for Emphysema Palliation Trial ( VENT) : a non-surgical method of lung volume reduction. BMC Pulm Med, 2007, 7: 10.
17. 沈寧, 姚婉貞, 郝振婷, 等. 經支氣管鏡肺減容術初探. 中國呼吸與危重監護雜志, 2006, 5: 31-34.
18. 王萍, 王瑞娟, 霍秀青, 等. 經支氣管鏡肺減容術一例報告. 中國呼吸與危重監護雜志, 2006, 5: 202-203.
19. Ingenito EP, Reilly JJ, Mentzer SJ, et al. Bronchoscopic volume reduction: a safe and effective alternative to surgical therapy for emphysema. Am J Respir Crit Care Med, 2001, 164: 295-301.
20. Ingenito EP, Berger RL, Henderson AC, et al. Bronchoscopic lung volume reduction using tissue engineering principles. Am J Respir Crit Care Med, 2003, 167: 771-778.
21. Reilly J, Washko G, Pinto-Plata V, et al. Biological lung volume reduction: a new bronchoscopic therapy for advanced emphysema.Chest, 2007, 131: 1108-1113.
22. 王萬勝, 朱赤, 張德志, 等. 平陽霉素碘油乳劑栓塞肺減容術的初步研究. 介入放射學雜志, 2006, 15: 36-40.
23. 楊和平, 戴曉天, 王海晶, 等. 經纖支鏡行肺減容術機制初步探討. 重慶醫學, 2008, 37: 119-121.
24. Lausberg HF, Chino K, Patterson GA, et al. Bronchial fenestration improves expiratory flow in emphysematous human lungs. Ann Thorac Surg, 2003, 75: 393-397.
25. Rendina EA, De Giacomo T, Venta F, et al. Feasibility and safety of the airway bypass procedure for patients with emphysema. J Thorac Cardiovasc Surg, 2003, 125: 1294-1299.

Chinese Journal of Respiratory and Critical Care Medicine

The Progress of Bronchoscopic Lung Volume Reduction in Treating COPD

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