Neder J Alberto, O'Donnell Denis E
Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University and Kingston General Hospital, Kingston, ON, Canada K7L 2V6.
Can Respir J. 2016;2016:6462352. doi: 10.1155/2016/6462352. Epub 2016 May 17.
There has been a surge of interest in endoscopic lung volume reduction (ELVR) strategies for advanced COPD. Valve implants, coil implants, biological LVR (BioLVR), bronchial thermal vapour ablation, and airway stents are used to induce lung deflation with the ultimate goal of improving respiratory mechanics and chronic dyspnea. Patients presenting with severe air trapping (e.g., inspiratory capacity/total lung capacity (TLC) < 25%, residual volume > 225% predicted) and thoracic hyperinflation (TLC > 150% predicted) have the greatest potential to derive benefit from ELVR procedures. Pre-LVRS or ELVR assessment should ideally include cardiological evaluation, high resolution CT scan, ventilation and perfusion scintigraphy, full pulmonary function tests, and cardiopulmonary exercise testing. ELVR procedures are currently available in selected Canadian research centers as part of ethically approved clinical trials. If a decision is made to offer an ELVR procedure, one-way valves are the first option in the presence of complete lobar exclusion and no significant collateral ventilation. When the fissure is not complete, when collateral ventilation is evident in heterogeneous emphysema or when emphysema is homogeneous, coil implants or BioLVR (in that order) are the next logical alternatives.
对于晚期慢性阻塞性肺疾病（COPD），内镜下肺减容（ELVR）策略引发了人们极大的兴趣。瓣膜植入、线圈植入、生物肺减容（BioLVR）、支气管热蒸汽消融和气道支架被用于诱导肺萎陷，最终目标是改善呼吸力学和慢性呼吸困难。出现严重气体潴留（如吸气容量/肺总量（TLC）<25%，残气量>预测值的225%）和胸廓过度充气（TLC>预测值的150%）的患者最有可能从ELVR手术中获益。理想情况下，肺减容术前或ELVR评估应包括心脏评估、高分辨率CT扫描、通气和灌注闪烁扫描、全面的肺功能测试以及心肺运动测试。目前，在加拿大选定的研究中心，ELVR手术作为符合伦理批准的临床试验的一部分可供使用。如果决定进行ELVR手术，在存在完全肺叶不张且无明显侧支通气的情况下，单向瓣膜是首选。当肺裂不完整、在异质性肺气肿中侧支通气明显或肺气肿为均匀性时，线圈植入或BioLVR（按此顺序）是接下来合理的选择。
