Fann James I, Berry Gerald J, Burdon Thomas A
Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford 94305, and The Section of Cardiothoracic Surgery, Palo Alto Veterans Affairs HCS, Palo Alto, CA, USA.
Respir Med. 2006 Aug;100(8):1402-6. doi: 10.1016/j.rmed.2005.11.011. Epub 2006 Jan 11.
We evaluated an endobronchial valve device in the treatment of surgically created air leak or pneumothorax by eliminating antegrade flow.
Six sheep underwent general anesthesia with positive pressure ventilation and left thoracotomy. After division of the mediastinal pleura, the contralateral cranial lobe was identified and a 2.5 cmx1.5 cm laceration created with resultant air leak. Using bronchoscopy, we deployed a valve device in the bronchus of the injured segment. Chest drainage tube was placed and the thoracotomy closed. At 1 week (n=3) and 4 weeks (n=3), the animals underwent general anesthesia, bronchoscopy and right thoracotomy.
All animals survived the procedure. Bronchoscopic valve device placement in the segmental bronchus resolved the air leak immediately. After closure of thoracotomy, the chest tube demonstrated minimal drainage with no air leak. At 1 and 4 weeks, bronchoscopy showed no change in device location, and the treated segments were atelectatic with fibrous scar at the injured site.
Collapse of a selected lung segment with resolution of air leak can be achieved using bronchoscopically implanted valve device. The valve device may facilitate treatment of patients with post-surgical or post-traumatic persistent air leak.
我们通过消除顺行气流来评估一种支气管内瓣膜装置在治疗手术造成的漏气或气胸方面的效果。
六只绵羊接受全身麻醉并进行正压通气，然后行左胸开胸手术。纵隔胸膜切开后，识别对侧颅叶并制造一个2.5厘米×1.5厘米的撕裂伤，导致漏气。通过支气管镜检查，我们在受伤节段的支气管中部署了一个瓣膜装置。放置胸腔引流管并关闭开胸切口。在1周（n = 3）和4周（n = 3）时，动物接受全身麻醉、支气管镜检查和右胸开胸手术。
所有动物均在手术过程中存活。在节段支气管中放置支气管镜瓣膜装置立即解决了漏气问题。开胸切口关闭后，胸腔引流管显示引流极少且无漏气。在1周和4周时，支气管镜检查显示装置位置无变化，治疗节段肺不张，受伤部位有纤维瘢痕。
使用支气管镜植入瓣膜装置可实现选定肺段的萎陷并解决漏气问题。该瓣膜装置可能有助于治疗术后或创伤后持续性漏气的患者。
