Choi Miyoung, Lee Worl Suk, Lee Min, Jeon Kyeongman, Sheen Seungsoo, Jheon Sanghoon, Kim Young Sam
National Evidence-Based Healthcare Collaborating Agency, Seoul, Republic of Korea.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Int J Chron Obstruct Pulmon Dis. 2015 Mar 31;10:703-10. doi: 10.2147/COPD.S75314. eCollection 2015.
Bronchoscopic lung volume reduction (BLVR) can be suggested as an alternative for surgical lung volume reduction surgery for severe emphysema patients. This article intends to evaluate by systematic review the safety and effectiveness of BLVR using a one-way endobronchial valve.
A systematic search of electronic databases, including MEDLINE, EMBASE, and the Cochrane Library, as well as eight domestic databases up to December 2013, was performed. Two reviewers independently screened all references according to selection criteria. The Scottish Intercollegiate Guidelines Network criterion was used to assess quality of literature. Data from randomized controlled trials were combined and meta-analysis was performed.
This review included 15 studies. Forced expiratory volume in 1 second (FEV1) improved in the intervention group compared with the control group (mean difference [MD]=6.71, 95% confidence interval [CI]: 3.31-10.11). Six-minute walking distance (MD=15.66, 95% CI: 1.69-29.64) and cycle workload (MD=4.43, 95% CI: 1.80-7.07) also improved. In addition, St George's Respiratory Questionnaire score decreased (MD=4.29, 95% CI: -6.87 to -1.71) in the intervention group. In a subgroup analysis of patients with complete fissure, the FEV1 change from baseline was higher in the BLVR group than in the control group for both 6 months (MD=15.28, P<0.001) and 12 months (MD=17.65, P<0.001), whereas for patients with incomplete fissure, FEV1 and 6-minute walking distance showed no change. One-year follow-up randomized controlled trials reported deaths, although the cause of death was not related to BLVR. Respiratory failure and pneumothorax incidence rates were relatively higher in the BLVR group, but the difference was not significant.
BLVR may be an effective and safe procedure for the treatment of severe COPD patients with emphysema, based on existing studies.
对于重度肺气肿患者，支气管镜肺减容术（BLVR）可作为外科肺减容手术的替代方案。本文旨在通过系统评价评估使用单向支气管内瓣膜的BLVR的安全性和有效性。
对电子数据库进行系统检索，包括MEDLINE、EMBASE和Cochrane图书馆，以及截至2013年12月的八个国内数据库。两名评价者根据选择标准独立筛选所有参考文献。采用苏格兰校际指南网络标准评估文献质量。对随机对照试验的数据进行合并并进行荟萃分析。
本评价纳入15项研究。与对照组相比，干预组的1秒用力呼气量（FEV1）有所改善（平均差值[MD]=6.71，95%置信区间[CI]：3.31-10.11）。6分钟步行距离（MD=15.66，95%CI：1.69-29.64）和运动负荷（MD=4.43，95%CI：1.80-7.07）也有所改善。此外，干预组圣乔治呼吸问卷评分降低（MD=4.29，95%CI：-6.87至-1.71）。在完全性肺裂患者的亚组分析中，BLVR组在6个月（MD=15.28，P<0.001）和12个月（MD=17.65，P<0.001）时FEV1较基线的变化均高于对照组，而对于不完全性肺裂患者，FEV1和6分钟步行距离无变化。1年随访的随机对照试验报告了死亡情况，尽管死亡原因与BLVR无关。BLVR组呼吸衰竭和气胸发生率相对较高，但差异无统计学意义。
根据现有研究，BLVR可能是治疗重度慢性阻塞性肺疾病合并肺气肿患者的一种有效且安全的方法。
