Ost David E, Ernst Armin, Grosu Horiana B, Lei Xiudong, Diaz-Mendoza Javier, Slade Mark, Gildea Thomas R, Machuzak Michael S, Jimenez Carlos A, Toth Jennifer, Kovitz Kevin L, Ray Cynthia, Greenhill Sara, Casal Roberto F, Almeida Francisco A, Wahidi Momen M, Eapen George A, Feller-Kopman David, Morice Rodolfo C, Benzaquen Sadia, Tremblay Alain, Simoff Michael
Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
Reliant Medical Group, Worcester, MA.
Chest. 2015 May;147(5):1282-1298. doi: 10.1378/chest.14-1526.
There is significant variation between physicians in terms of how they perform therapeutic bronchoscopy, but there are few data on whether these differences impact effectiveness.
This was a multicenter registry study of patients undergoing therapeutic bronchoscopy for malignant central airway obstruction. The primary outcome was technical success, defined as reopening the airway lumen to > 50% of normal. Secondary outcomes were dyspnea as measured by the Borg score and health-related quality of life (HRQOL) as measured by the SF-6D.
Fifteen centers performed 1,115 procedures on 947 patients. Technical success was achieved in 93% of procedures. Center success rates ranged from 90% to 98% (P = .02). Endobronchial obstruction and stent placement were associated with success, whereas American Society of Anesthesiology (ASA) score > 3, renal failure, primary lung cancer, left mainstem disease, and tracheoesophageal fistula were associated with failure. Clinically significant improvements in dyspnea occurred in 90 of 187 patients measured (48%). Greater baseline dyspnea was associated with greater improvements in dyspnea, whereas smoking, having multiple cancers, and lobar obstruction were associated with smaller improvements. Clinically significant improvements in HRQOL occurred in 76 of 183 patients measured (42%). Greater baseline dyspnea was associated with greater improvements in HRQOL, and lobar obstruction was associated with smaller improvements.
Technical success rates were high overall, with the highest success rates associated with stent placement and endobronchial obstruction. Therapeutic bronchoscopy should not be withheld from patients based solely on an assessment of risk, since patients with the most dyspnea and lowest functional status benefitted the most.
医生在进行治疗性支气管镜检查的方式上存在显著差异，但关于这些差异是否会影响疗效的数据却很少。
这是一项针对因恶性中央气道阻塞接受治疗性支气管镜检查患者的多中心登记研究。主要结局是技术成功，定义为将气道腔重新开放至正常的>50%。次要结局是通过Borg评分测量的呼吸困难以及通过SF-6D测量的健康相关生活质量（HRQOL）。
15个中心对947例患者进行了1115例手术。93%的手术取得了技术成功。各中心的成功率在90%至98%之间（P = 0.02）。支气管内阻塞和支架置入与成功相关，而美国麻醉医师协会（ASA）评分>3、肾衰竭、原发性肺癌、左主支气管疾病和气管食管瘘与失败相关。在187例接受测量的患者中，有90例（48%）的呼吸困难出现了具有临床意义的改善。基线呼吸困难程度越高，呼吸困难改善越明显，而吸烟、患有多种癌症和肺叶阻塞则与较小的改善相关。在183例接受测量的患者中，有76例（42%）的HRQOL出现了具有临床意义的改善。基线呼吸困难程度越高，HRQOL改善越明显，肺叶阻塞与较小的改善相关。
总体技术成功率较高，最高成功率与支架置入和支气管内阻塞相关。不应仅基于风险评估而不给患者进行治疗性支气管镜检查，因为呼吸困难最严重且功能状态最差的患者受益最大。
