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。
Objective To evaluate the clinical effects of bronchial artery embolization ( BAE) for massive hemoptysis due to bronchiectasis.Methods 205 patients with massive hemoptysis were treated with bronchial artery embolization using coils, polyvinyl alcohol ( PVA) microspheres, line segmen, and gelatin sponge after the site of bleeding or the abnormal arteries were identified by arteriography. Super selective bronchial artery embolization was performed with a coaxial microcatheter inserted into the bronchial artery. Results BAE was successfully performed in 205 cases with massive hemoptysis ( left and right bronchial artery embolization in 35 cases, left bronchial artery embolization in 20 cases, right bronchial artery embolization in 126 cases, common bronchial artery embolization in 22 cases, right inferior phrenic artery embolization in 2 cases) . Of 205 patients, 169 were cured, 24 were relieved with a success rate of 94.1% . Long termcumulative hemoptysis nonrecurrence rates was 82.4% . 23 patients developed post embolization syndrome characterized by mild fever and chest pain and ended with spontaneous recovery without special management. No severe complications including spinal cord injury or dystopia embolization were observed. Conclusions Bronchial arterial embolization interventional therapy is a rapid, safe and effective method in the treatment of massive hemoptysis due to bronchiectasis.
Objective To investigate the feasibility and therapeutic efficacy of inverted Y-shaped self-expandable metal airway stent for complex airway diseases ( stenosis or fistula) .Methods According to the particular anatomic structure and the pathological changes of complex airway diseases, the inverted Y-shaped self-expandable metal airway stent was designed. 10 stents were implanted in 10 cases of airway complex diseases under the guidance of interventional fibroscopy and fluoroscopy. Results The inverted Y-shaped stents were placed successfully with immediate relief of the symptoms. 100% of the patients were able to be weaned fromoxygen therapy completely. Dyspnea grade improved significantly fromⅢ-Ⅳ to 0-Ⅱ,and oxygen saturation elevated from ( 85 ±5) % in inspiring high concentration oxygen to ( 95 ±3) % in breathing ambient air ( t = - 7. 352, P lt;0. 05) . Breathlessness in 2 cases with tracheoesophageal fistula was relieved after inserting covered airway stent without bucking while foodintaking after fasting 24 hours.Conclusion The placement of inverted Y-shaped self-expandable metal airway stent is a feasible and safetreatment for complex airway disease such as stenosis or fistula.
Objective To summarize the diagnosis and treatment of spontaneous rupture of bronchial artery aneurysm in mediastinum.Methods Two cases diagnosed as bronchial artery aneurysmby methods of enhanced-CT plus independent post-procedure techniques and bronchial artery selective angiography were cured by different intervention surgeries in our hospital. The clinical data of these two patients and different interventional treatments were summarized.Results Case 1 was a 38-year old male.He was given coils and PVC micro-particles, and bronchial artery selective angiography showed distal vascular occlusion and aneurysmsize decreased. Case 2 was a 59-year old female. She was also given coils, but digital subtraction angiography showed bleeding of bronchial artery whose opening was near to the aorta.Then a stent was implanted in the descending aorta to isolate the bleeding bronchial artery, and bronchial artery selective angiography showed blood flow was completely blocked. Conclusions Enhanced-CT plus vascular three-dimensional reconstruction and bronchial artery selective angiography is a chief method to diagnose bronchial artery aneurysm. Bronchial artery embolization and/ or isolating surgery with covered stent are minimally invasive, efficient, trustworthy treatment for spontaneous rupture of bronchial-artery aneurysmin mediastinum. Different techniques of interventional treatment are selected depending on lesion.