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。
Objective To evaluate the application value of spiral CT virtual endoscopy and three dimensional imaging in fiberoptic bronchoscopic balloon dilation in patients with benign tracheobronchial stenosis. Methods Thirty-three cases of benign tracheobronchial stenosis from June 2004 to November 2008 were checked by spiral CT with airway tracheobronchial reconstruction. For the patients with indications, balloon dilatation was performed under fiberoptic bronchoscope. The three-dimensional reconstruction images were compared with the findings under bronchoscopy. And the preoperative and postoperative three-dimensional reconstruction images were compared for airway diameter. Results Three cases were found stenosis of middle lobe by CT virtual endoscopy and did not undergo balloon dilatation. The remaining 30 cases were confirmed by bronchoscopy findings similar to the images by tracheobronchial reconstruction with CT, with consistent rate of 100% . Immediate postoperative three-dimensional CTreconstruction of tracheal bronchus revealed that diameter of stenotic bronchus increased from ( 2. 7 ±1. 3) mm to ( 6. 9 ±1. 6) mmafter operation. Conclusion Multislice spiral CT virtual endoscopy is helpful in fiberoptic bronchoscopic balloon dilation in patients with benign tracheobronchial stenosis and postoperative follow-up.
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.