Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Curr Opin Anaesthesiol. 2014 Feb;27(1):36-43. doi: 10.1097/ACO.0000000000000039.
Chronic obstructive pulmonary disease (COPD) is a progressive, debilitating disease that in its final stages cripples the patient. The disappointing results of the National Emphysema Treatment Trial study led to a decrease in the acceptance of lung volume reduction surgery as a therapy. Thus, it became clear that debilitated COPD patients would need innovative alternative nonsurgical procedures to potentially alleviate their symptoms. This review will address the various techniques of bronchoscopic lung volume reduction (BLVR).
In recent years, a variety of noninvasive BLVR procedures were developed in the hope of improving the respiratory status of these patients. BLVR aims to decrease the extent of hyperinflation due to emphysema and result in a beneficial effect similar to that from surgical resection. The most widely used BLVR devices are: endobronchial valves, foam sealant, metallic coils, airway bypass stents and vapor thermal ablation.In the USA, BLVR remains in the experimental phase. The treatment modalities should be individually tailored for each patient. Endobronchial valves are designed to exclude the most affected emphysematous regions from ventilation in order to induce lobar absorption atelectasis. Airway bypass stents target homogenous emphysema, whereas valves and thermal vapor ablation target heterogeneous emphysema. Biological sealants and endoscopic coil implants have been used in both homogenous and heterogeneous emphysema.
BLVR appears to be safer than surgery and presents an attractive alternative for the treatment of COPD patients. Unfortunately, the outcome data to date are inconclusive; the procedures remain experimental and any benefits unproven. However, the data that are emerging continue to appear promising.
慢性阻塞性肺疾病（COPD）是一种进行性、使人虚弱的疾病，在疾病晚期会使患者致残。国家肺气肿治疗试验研究的结果令人失望，导致人们对肺减容手术作为一种治疗方法的接受度降低。因此，显然需要为衰弱的 COPD 患者提供创新的替代非手术治疗方法，以潜在缓解他们的症状。本综述将讨论各种支气管镜肺减容术（BLVR）的技术。
近年来，为了改善这些患者的呼吸状况，开发了多种非侵入性 BLVR 技术。BLVR 的目的是减少肺气肿引起的过度充气程度，并产生与手术切除相似的有益效果。最广泛使用的 BLVR 设备是：支气管内瓣膜、泡沫密封剂、金属线圈、气道旁路支架和蒸汽热消融。在美国，BLVR 仍处于实验阶段。治疗方式应根据每位患者的具体情况进行定制。支气管内瓣膜旨在使最受影响的肺气肿区域无法通气，从而诱导肺叶吸收性肺不张。气道旁路支架针对均匀性肺气肿，而瓣膜和热蒸汽消融针对异质性肺气肿。生物密封剂和内镜线圈植入物已用于均匀性和异质性肺气肿。
BLVR 似乎比手术更安全，为 COPD 患者的治疗提供了一种有吸引力的替代方案。不幸的是，迄今为止的结果数据尚无定论；该程序仍处于实验阶段，任何益处都未经证实。然而，不断出现的数据仍然很有希望。
