Mink Steven N, Gonzalez Xavier, Duke Krika, Bautista Edgar, Tan Lawrence
Section of Respiratory, Department of Internal Medicine, University of Manitoba Health Sciences Centre, 700 William Avenue, Winnipeg, Manitoba R3E-0Z3, Canada.
Chest. 2004 Feb;125(2):633-43. doi: 10.1378/chest.125.2.633.
Lung volume reduction surgery has been shown to be an effective treatment for selected patients with advanced emphysema. Nevertheless, prolonged air leaks are a significant complication that limits the utility of this procedure. This study evaluated the safety and effectiveness of a novel surgical system designed to minimize this complication.
In 14 dogs, severe upper lobe emphysema was produced by repeated bronchial instillations of papain administered over an approximate 6-month interval. Pulmonary function testing that included lung volumes and flows was performed at baseline, after emphysema, and at 1 month and 6 months after resection in the surgical group, while at comparable intervals in the nonsurgical group. Seven animals were randomly assigned to a surgical group to test a vacuum-assisted surgical system (VALR Surgical System; Spiration; Redmond, WA) that deploys a compression silicone sleeve over portions of the diseased tissue. The other seven dogs comprised the nonsurgical group.
In both groups, emphysema increased total lung capacity (TLC) approximately 125% as compared to baseline. In the surgical group, no air leaks were observed after resection, and TLC significantly decreased at the 1-month and 6-month periods as compared with postemphysema measurements. At necropsy, histologic examination revealed fibrosis of the compressed lung contained within the sleeve and fibrotic encapsulation of the device. Two animals had evidence of localized infection.
We successfully created a model of predominantly upper lobe emphysema. The vacuum-assisted surgical system provided safe and effective lung reduction without air leak complications and with sustained improvement in pulmonary function over 6 months.
肺减容手术已被证明是治疗部分晚期肺气肿患者的有效方法。然而，长时间的气胸是一种严重的并发症，限制了该手术的应用。本研究评估了一种旨在减少这一并发症的新型手术系统的安全性和有效性。
在14只犬中，通过每隔约6个月重复支气管内注入木瓜蛋白酶来诱发严重的上叶肺气肿。手术组在基线、肺气肿形成后、切除术后1个月和6个月进行包括肺容积和气流的肺功能测试，非手术组在相应时间间隔进行测试。7只动物被随机分配到手术组，以测试一种真空辅助手术系统（VALR手术系统；Spiration公司；华盛顿州雷德蒙德），该系统在病变组织部分部署一个压缩硅胶套管。另外7只犬组成非手术组。
两组中，与基线相比，肺气肿使肺总量（TLC）增加了约125%。手术组切除术后未观察到气胸，与肺气肿后测量值相比，TLC在1个月和6个月时显著下降。尸检时，组织学检查显示套管内压缩肺组织纤维化以及装置的纤维包裹。2只动物有局部感染迹象。
我们成功创建了一个以上叶为主的肺气肿模型。真空辅助手术系统提供了安全有效的肺减容，无气胸并发症，且肺功能在6个月内持续改善。
