Tidwell Sherry L, Westfall Elizabeth, Dransfield Mark T
Department of Medicine, Division of Pulmonary Allergy and Critical Care, University of Alabama at Birmingham, Birmingham, AL, USA.
South Med J. 2012 Jan;105(1):56-61. doi: 10.1097/SMJ.0b013e31823c5c49.
Chronic obstructive pulmonary disease is the third leading cause of death in the United States, affecting more than 24 million people. Inhaled bronchodilators are the mainstay of therapy; they improve symptoms and quality of life and reduce exacerbations. These and smoking cessation and long-term oxygen therapy for hypoxemic patients are the only medical treatments definitively demonstrated to reduce mortality. Surgical approaches include lung transplantation and lung volume reduction and the latter has been shown to improve exercise tolerance, quality of life, and survival in highly selected patients with advanced emphysema. Lung volume reduction surgery results in clinical benefits. The procedure is associated with a short-term risk of mortality and a more significant risk of cardiac and pulmonary perioperative complications. Interest has been growing in the use of noninvasive, bronchoscopic methods to address the pathological hyperinflation that drives the dyspnea and exercise intolerance that is characteristic of emphysema. In this review, the mechanism by which lung volume reduction improves pulmonary function is outlined, along with the risks and benefits of the traditional surgical approach. In addition, the emerging bronchoscopic techniques for lung volume reduction are introduced and recent clinical trials examining their efficacy are summarized.
慢性阻塞性肺疾病是美国第三大死因，影响着超过2400万人。吸入性支气管扩张剂是治疗的主要手段；它们能改善症状和生活质量，并减少病情加重。这些药物以及戒烟和对低氧血症患者的长期氧疗是唯一经明确证实可降低死亡率的医学治疗方法。手术方法包括肺移植和肺减容术，后者已被证明可改善重度肺气肿特定患者的运动耐量、生活质量和生存率。肺减容手术带来临床益处。该手术伴有短期死亡风险以及更显著的心脏和肺部围手术期并发症风险。使用非侵入性支气管镜方法来解决导致肺气肿特征性呼吸困难和运动不耐受的病理性肺过度充气的兴趣一直在增加。在这篇综述中，概述了肺减容改善肺功能的机制，以及传统手术方法的风险和益处。此外，还介绍了新兴的支气管镜肺减容技术，并总结了近期检验其疗效的临床试验。
