NIHR Respiratory Disease Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital Campus, London, SW3 6NP, UK.
Eur Respir J. 2011 Jun;37(6):1346-51. doi: 10.1183/09031936.00100110. Epub 2010 Oct 14.
Bronchoscopic therapies to reduce lung volumes in chronic obstructive pulmonary disease are intended to avoid the risks associated with lung volume reduction surgery (LVRS) or to be used in patient groups in whom LVRS is not appropriate. Bronchoscopic lung volume reduction (BLVR) using endobronchial valves to target unilateral lobar occlusion can improve lung function and exercise capacity in patients with emphysema. The benefit is most pronounced in, though not confined to, patients where lobar atelectasis has occurred. Few data exist on their long-term outcome. 19 patients (16 males; mean±sd forced expiratory volume in 1 s 28.4±11.9% predicted) underwent BLVR between July 2002 and February 2004. Radiological atelectasis was observed in five patients. Survival data was available for all patients up to February 2010. None of the patients in whom atelectasis occurred died during follow-up, whereas eight out of 14 in the nonatelectasis group died (Chi-squared p=0.026). There was no significant difference between the groups at baseline in lung function, quality of life, exacerbation rate, exercise capacity (shuttle walk test or cycle ergometry) or computed tomography appearances, although body mass index was significantly higher in the atelectasis group (21.6±2.9 versus 28.4±2.9 kg·m(-2); p<0.001). The data in the present study suggest that atelectasis following BLVR is associated with a survival benefit that is not explained by baseline differences.
支气管镜下肺减容术旨在避免与肺减容手术（LVRS）相关的风险，或用于 LVRS 不适用的患者群体。使用支气管内瓣膜靶向单侧肺叶闭塞的支气管镜下肺减容术（BLVR）可以改善肺气肿患者的肺功能和运动能力。其获益在发生肺叶萎陷的患者中最为明显，但并不仅限于此类患者。关于其长期结果的数据很少。19 名患者（16 名男性；平均±标准差用力呼气量 1 秒 28.4±11.9%预计值）于 2002 年 7 月至 2004 年 2 月期间接受 BLVR。5 名患者出现影像学肺萎陷。所有患者的生存数据均可获得至 2010 年 2 月。在随访期间，发生肺萎陷的患者中无人死亡，而非肺萎陷组的 14 名患者中有 8 人死亡（卡方检验 p=0.026）。在肺功能、生活质量、恶化率、运动能力（穿梭步行试验或循环测力计）或计算机断层扫描表现方面，两组在基线时无显著差异，尽管肺萎陷组的体重指数显著较高（21.6±2.9 与 28.4±2.9 kg·m(-2)；p<0.001）。本研究的数据表明，BLVR 后发生肺萎陷与生存获益相关，而这种获益不能用基线差异来解释。
