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是以气流受限不完全可逆为特征,可伴有肺组织破坏导致其弹性回缩力减低和肺过度膨胀,呈进行性发展的一种疾病。OPD的总患病率为6%,其中肺气肿患病率为1.8%,是美国疾病死亡的第四大原因,而且每年呈现上升趋势,给全球社会和经济带来严重负担,严重威胁人类健康。内科保守治疗能减轻患者病情,但对病情进程的影响还有待进一步研究。外科肺减容术(LVRS)通过切除严重肺气肿组织可恢复肺的弹性回缩力,使邻近相对正常肺组织扩张,在呼气时维持气道扩张,使气道阻力下降;使肺容积缩小,肺的顺应性增加,减少无效腔,改善肺的弥散功能;恢复肺、胸廓以及膈肌的弹性,缓解压迫,有利于减少肺心血管阻力及右心负荷,改善右心功能。美国肺气肿国家试验研究(NETT)结果肯定了LVRS方法的有效性,但适应证仅限于上叶病变、活动受限的非均质性肺气肿患者,而且创伤大,并发症多,风险高。于是便催生了经支气管镜肺减容术(BLVR)这一新技术,其主要思路有:放置支气管内单向活瓣或气道内塞装置使其靶肺不张;注入生物胶粘剂使过度充气肺组织萎陷、重构及人工气道旁路增加呼出气量。本文就近年来国内外BLVR的研究现状和进展综述如下。

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. 螺圈加胶水法封堵兔肺支气管的实验研究. 介入放射学杂志, 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.	沈宁, 姚婉贞, 郝振婷, 等. 经支气管镜肺减容术初探. 中国呼吸与危重监护杂志, 2006, 5: 31-34.
18.	王萍, 王瑞娟, 霍秀青, 等. 经支气管镜肺减容术一例报告. 中国呼吸与危重监护杂志, 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.	王万胜, 朱赤, 张德志, 等. 平阳霉素碘油乳剂栓塞肺减容术的初步研究. 介入放射学杂志, 2006, 15: 36-40.
23.	杨和平, 戴晓天, 王海晶, 等. 经纤支镜行肺减容术机制初步探讨. 重庆医学, 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. 螺圈加胶水法封堵兔肺支气管的实验研究. 介入放射学杂志, 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. 沈宁, 姚婉贞, 郝振婷, 等. 经支气管镜肺减容术初探. 中国呼吸与危重监护杂志, 2006, 5: 31-34.
18. 王萍, 王瑞娟, 霍秀青, 等. 经支气管镜肺减容术一例报告. 中国呼吸与危重监护杂志, 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. 王万胜, 朱赤, 张德志, 等. 平阳霉素碘油乳剂栓塞肺减容术的初步研究. 介入放射学杂志, 2006, 15: 36-40.
23. 杨和平, 戴晓天, 王海晶, 等. 经纤支镜行肺减容术机制初步探讨. 重庆医学, 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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