Yu W C, Yu E Lm, Kwok H C, She H L, Kwong K K, Chan Y H, Tsang Y L, Yeung Y C
Department of Medicine and Geriatrics, Princess Margaret Hospital, Laichikok, Hong Kong.
Clinical Research Centre, Princess Margaret Hospital, Laichikok, Hong Kong.
Hong Kong Med J. 2018 Apr;24(2):158-165. doi: 10.12809/hkmj176823. Epub 2018 Apr 4.
Endobronchial one-way valves have been proposed as treatment for persistent air leak complicating spontaneous pneumothorax in which surgical intervention is not feasible. However, published data on efficacy, safety, and factors associated with success are scanty.
This is a retrospective study of 37 patients at a general hospital from 2008 to 2016. The impact of endobronchial valve implantation on the time to air-leak cessation after bronchoscopy was evaluated.
The median patient age was 71 years. The majority of patients were males (92%), were ever-smokers (83%), had at least one co-morbidity (97%), and had secondary spontaneous pneumothorax (89%). Nineteen patients (51%) had a mean of 2.6 endobronchial valves implanted (range, 1-6). The air leak ceased within 72 hours for only eight patients (22% of the complete cohort), with immediate air-leak cessation after completion of endobronchial valve implantation. All six successful cases that had computed tomographic data of the thorax were shown to have bilateral intact interlobar fissures. The median (interquartile range) Charlson co-morbidity index was 1 (0.25-1) and 2 (1-3) for the success group and failure group, respectively (P=0.029). All patients in the no-endobronchial valve group survived, whereas three patients in the endobronchial valve group died within 30 days of endobronchial valve implantation.
Only a small proportion of cases of endobronchial valve implantation for air leak complicating pneumothorax had unequivocal success. Intact bilateral interlobar fissures appear to be a necessary, though not sufficient, condition for success. Patients with fewer medical co-morbidities and immediate air-leak cessation after endobronchial valve implantation have a higher likelihood of success.
支气管内单向阀已被提议用于治疗自发性气胸合并持续性漏气且手术干预不可行的情况。然而，关于其疗效、安全性及成功相关因素的已发表数据较少。
这是一项对2008年至2016年一家综合医院37例患者的回顾性研究。评估了支气管内瓣膜植入对支气管镜检查后漏气停止时间的影响。
患者中位年龄为71岁。大多数患者为男性（92%），曾经吸烟（83%），至少有一种合并症（97%），且为继发性自发性气胸（89%）。19例患者（51%）平均植入2.6个支气管内瓣膜（范围为1 - 6个）。仅8例患者（占整个队列的22%）在72小时内漏气停止，且在支气管内瓣膜植入完成后立即停止漏气。所有6例有胸部计算机断层扫描数据的成功病例均显示双侧叶间裂完整。成功组和失败组的Charlson合并症指数中位数（四分位间距）分别为1（0.25 - 1）和2（1 - 3）（P = 0.029）。无支气管内瓣膜组的所有患者均存活，而支气管内瓣膜组有3例患者在支气管内瓣膜植入后30天内死亡。
对于气胸合并漏气植入支气管内瓣膜的病例，只有一小部分取得了明确成功。双侧叶间裂完整似乎是成功的必要条件，但并非充分条件。合并症较少且在支气管内瓣膜植入后立即停止漏气的患者成功可能性更高。
