活瓣治疗肺大疱成功病例分享

1、EBV成功治疗肺大疱一例成功治疗肺大疱一例EBV治疗（治疗（RML）术前术前术后术后1月复查月复查CT患者，男，患者，男，67岁，右肺大疱入院，患者一般状况不能耐受外科手术岁，右肺大疱入院，患者一般状况不能耐受外科手术本例肺大疱病人小结：本例肺大疱病人小结：1.成功经验：成功经验： 术前：术前：CT确认了肺大疱的部位，明确了大疱的支气管通路确认了肺大疱的部位，明确了大疱的支气管通路 术中：术中：EBV封堵完全封堵完全2.不足之处：不足之处： 术前与术后：无肺功能、术前与术后：无肺功能、6MWT等相关检查等相关检查结果结果肺大疱的治疗流程肺大疱的治疗流程证明大疱与支气管是相通的并找到其通路（目前

2、方法与35年前的CT片对比）Chartis评估旁路通气评估旁路通气（大疱所在肺叶与相邻肺叶间）（大疱所在肺叶与相邻肺叶间）CV+CV-使用EBV封堵大疱所在肺叶不能使用不能使用EBV治疗治疗 肺大疱相关文献肺大疱相关文献使用单向活瓣支气管内治疗巨大的肺气肿大疱：使用单向活瓣支气管内治疗巨大的肺气肿大疱：一种用于不适合外科治疗患者的新途径一种用于不适合外科治疗患者的新途径EJCTS-8365; N o. of Pages 7Pl ease ci t e t hi s art i cl e i n press as: Sant i ni M , et al . Endobronchi al t r

3、eat m ent of gi ant em physem at ous bul l ae w i t h one-w ay val ves: a newapproach for surgi cal l y unfit pat i ent s. Eur J Cardi ot horac Surg (2011), doi :10. 1016/ j . ej ct s. 2011. 03. 046Endobronchi al treatm ent of gi ant em physem atous bul l ae w i thone-w ay val ves: a new approach fo

4、r surgi cal l y unfit pati entsM ari o Santi ni*, Al fonso Fi orel l i , Gi ovanni Vi ci dom i ni , Vi ncenzo Gi useppe Di Crescenzo,Gaetana M essi na, Paol o LaperutaThoracic Surgery Unit, Second University of Naples, Naples, I talyRecei ved 20 February 2011; recei ved i n revi sed form 23 M arch 2

5、011; accepted 25 M arch 2011AbstractObjecti ve: W e ai m ed to eval uate the feasi bi l i ty and short-term efficacy of endobronchi al treatm ent w i th one-w ay val ves for gi antem physem atous bul l a i n surgi cal l y unfit pati ents. M ethods: Ni ne consecuti ve pati ents w i th gi ant em physe

6、m atous bul l a w ere enrol l ed i n thel ast 3 years. Endobronchi al val ves w ere pl aced i n the segm ental bronchi to functi onal l y i sol ate the ai rw ay that suppl i ed the bul l a, favouri ng thedeflati on of the bul l a and i ts atel ectasis. M ean val ue standard devi ati on of forced exp

7、i ratory vol um e i n 1 s (FEV1), preoperati ve forced vi talcapaci ty (FVC) and resi dual vol um e (RV) w ere: 1.0 0.2 l (35 9.9%), 1.5 0.5 l (42 12%) and 5.5 0.7 l (231 32%), respecti vel y; and theval ues for di ffusi on capaci ty for carbon m onoxi de w as 31 4.6% and for the 6-m i n w al k test

8、 (6M W T) w as 156 92 m ); al l pati ents requi redsuppl em ental oxygen at rest. The St. George s Respi ratory Questi onnai re (SGRQ) score w as 85 4.6. Resul ts: At 24 48 h after the procedure, them ean val ue of FEV1 (from 35% to 47%, p 0.01), FVC (from 42% to 52%, p 0.01), di ffusi on l ung capa

9、ci ty for carbon m onoxi de (DLCO) (from 31%to 33%, p 0.05) and 6M W T (from 156 m to 281 m , p 0.01) si gni ficantl y i m proved w i th respect to basel i ne val ue. Conversel y, m ean val ue oftotal l ung capaci ty (TLC) (from 157% to 123%, p 0.01) RV (from 231% to 158%, p 0.01) and SGRQ score (fr

10、om 85 to 37, p 0.01) w assi gni ficantl y l ow er than basel i ne data; these changes w ere preserved duri ng the enti re fol l ow -up. Concl usi on: Our prel i m i nary data confirm thefeasi bi l i ty and the potenti al efficacy of thi s strategy w i th si gni ficantl y i m m edi ate i m provem ent

11、 of respi rati on and qual i ty of l i fe, w hi ch rem ai nsstabl e duri ng 6 m onths of fol l ow -up.# 2011 European Associ ati on for Cardi o-Thoraci c Surgery. Publ i shed by El sevi er B.V. Al l ri ghts reserved.Keyw ords: Em physem a; Bul l a; Endobronchi al one-w ay val ves1. I ntroducti onGi

12、ant em physem atous bul l a (GEB) i s defined as ai r-fil l edspaces, w hi ch occupi es m ore than one-thi rd of the hem i -thorax and devel ops i n a l ung destroyed by general i sedem physem a 1. I n sel ected pati ents, surgery i s thetreatm ent of choi ce w i th i m provem ent of l ung functi on

13、and qual i ty of l i fe 2,3. A w i de vari ety of surgi cal procedureshave been proposed, such as l ocal exci si on of the bul l ae,pl i cati on, stapl er resecti on and l obectom y; vi deothoraco-scopy i s reported to be a good al ternati ve to thoracotom ybecause of i ts l ow er i nvasi veness. Ho

14、w ever , there are sti l lm any cases consi dered to be hi gh ri sk for surgery, despi tesurgi cal and anaesthesi ol ogi cal techni cal progress. I n suchpati ents, the opti m al treatm ent i s not sti l l found despi te avari ety of l ess i nvasi ve strategy havi ng been proposed 4 7.The Zephyr end

15、obronchi al val ves (EBVs; Zephyr; Pul m onxI nc., Redw ood Ci ty, CA, USA) have recentl y em erged as apossi bl e al ternati ve to l ung vol um e reducti on surgery (LVRS)i n sel ected pati ents, resul ti ng i n rel i ef of dyspnoea andi m proved functi onal status 8 10.Recentl y, w e reported the

16、first successful case i n w hi chthe EBVs w ere used for the treatm ent of GEB 11.Subsequentl y, w e have descri bed another case i n w hi ch suchdevi ce w as successful l y used to treat i atrogeni c ai r l eaks dueto an i nadvertent pl acem ent of chest drai n i n a GEB 12.Based on these experi en

17、ces, w e prospecti vel y fol l ow ed al lconsecuti ve pati ents w i th GEB consi dered unfit for surgeryand w ho thus underw ent to bronchoscopi c pl acem ent of EBV.The ai m of the present study i s to eval uate the feasi bi l i ty ofthi s techni que by assessi ng the earl y and l ate m odi ficati

18、ons ofpul m onary functi on data.2. M ateri al s and m ethods2.1. Study designThi s i s a prospecti ve, non-random i sed, uni centre study toeval uate the safety and short-term efficacy of EBVs for thew w w.el sevi /l ocate/ejctsEuropean Journal of Cardi o-thoraci c Surgery xxx (2011) xxx xxx* Correspondi ng author . Address: Chi rurgia Toraci ca Seconda Uni vers