Kontogianni Konstantina, Gerovasili Vasiliki, Gompelmann Daniela, Schuhmann Maren, Hoffmann Hans, Heussel Claus Peter, Herth Felix Jf, Eberhardt Ralf
Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik at the University of Heidelberg; Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany.
Department of Respiratory Medicine, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, UK.
Int J Chron Obstruct Pulmon Dis. 2017 Jan 23;12:383-394. doi: 10.2147/COPD.S117655. eCollection 2017.
Lung volume reduction coil (LVRC) treatment is established in daily endoscopic lung volume reduction routine. The aim of this study was to evaluate the safety and efficacy of LVRC treatment.
This was a retrospective analysis of 86 patients (male/female: 40/46, mean age: 64±7 years) with severe COPD and bilateral incomplete fissures. A total of 10 coils were unilaterally implanted in a single lobe, and 28 out of 86 patients were treated bilaterally. At 90-, 180-, and 365-day follow-up, changes in pulmonary function test (PFT), 6-minute walk test (6MWT) and modified Medical Research Council (mMRC) dyspnea scale, as well as possible complications, were recorded.
At 90 days, the forced expiratory volume in 1 second did improve (<0.001), but the improvement was not sustained at the 180- and 365-day follow-up (baseline: 0.71±0.21 vs 0.77±0.23 vs 0.73±0.22 vs 0.70±0.18 L). Both vital capacity and residual volume improved significantly (<0.001) at the 90- and 180-day follow-up, but the improvement was lost after 365 days. Total lung capacity decreased at the 90-day follow-up but returned to baseline values at the 180- and 365-day follow-up. 6MWT (=0.01) and mMRC (=0.007) also improved at 90 and 180 days (Δ6MWT of 31±54 and 20±60 m, respectively), but the improvement was also lost at the 365-day follow-up. No significant further improvement was evident at any point in the follow-up after the second procedure. A total of 4 out of 86 patients passed away due to complications. Significant complications in the first 3 months and then at 12 months included the following: severe hemoptysis in 4 (3.5%) and 4 (3.5%) patients, pneumonia requiring hospitalization in 32 (28.1%) and 9 (7.9%) patients and pneumothorax in 7 (6.1%) and 2 (1.7%) patients, respectively. Milder adverse events included self-limited hemoptysis, pneumonias, or COPD exacerbations treated orally.
LVRC improved PFT, 6MWT and mMRC initially, but the improvement was lost after 365 days. Furthermore, we observed 4 deaths and significant severe complications, which need to be further elucidated.
肺减容线圈（LVRC）治疗已成为日常内镜下肺减容常规操作。本研究旨在评估LVRC治疗的安全性和有效性。
这是一项对86例（男性/女性：40/46，平均年龄：64±7岁）重度慢性阻塞性肺疾病（COPD）且双侧肺裂不全患者的回顾性分析。共在单叶单侧植入10个线圈，86例患者中有28例接受了双侧治疗。在90天、180天和365天随访时，记录肺功能测试（PFT）、6分钟步行试验（6MWT）和改良医学研究委员会（mMRC）呼吸困难量表的变化以及可能出现的并发症。
在90天时，第1秒用力呼气量确实有所改善（<0.001），但在180天和365天随访时改善未持续（基线：0.71±0.21 vs 0.77±0.23 vs 0.73±0.22 vs 0.70±0.18 L）。肺活量和残气量在90天和180天随访时均显著改善（<0.001），但在365天后改善消失。肺总量在90天随访时下降，但在180天和365天随访时恢复至基线值。6MWT（=0.01）和mMRC（=0.007）在90天和180天时也有所改善（Δ6MWT分别为31±54和20±60 m），但在365天随访时改善也消失。在第二次手术后的任何随访时间点均未发现明显进一步改善。86例患者中有4例因并发症死亡。前3个月及12个月时的严重并发症如下：4例（3.5%）和4例（3.5%）患者出现严重咯血，32例（28.1%）和9例（7.9%）患者因肺炎需住院治疗，7例（6.1%）和2例（1.7%）患者分别出现气胸。较轻的不良事件包括自限性咯血、肺炎或口服药物治疗的COPD急性加重。
LVRC最初改善了PFT、6MWT和mMRC，但在365天后改善消失。此外，我们观察到4例死亡和严重并发症，这需要进一步阐明。
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