Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.
Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany.
Respiration. 2018;95(6):392-400. doi: 10.1159/000489815. Epub 2018 Jun 12.
Bronchoscopic thermal vapor ablation (BTVA) represents one of the endoscopic lung volume reduction (ELVR) techniques that aims at hyperinflation reduction in patients with advanced emphysema to improve respiratory mechanics. By targeted segmental vapor ablation, an inflammatory response leads to tissue and volume reduction of the most diseased emphysematous segments. So far, BTVA has been demonstrated in several single-arm trials and 1 multinational randomized controlled trial to improve lung function, exercise capacity, and quality of life in patients with upper lobe-predominant emphysema irrespective of the collateral ventilation. In this review, we emphasize the practical aspects of this ELVR method. Patients with upper lobe-predominant emphysema, forced expiratory volume in 1 second (FEV1) between 20 and 45% of predicted, residual volume (RV) > 175% of predicted, and carbon monoxide diffusing capacity (DLCO) ≥20% of predicted can be considered for BTVA treatment. Prior to the procedure, a special software assists in identifying the target segments with the highest emphysema index, volume and the highest heterogeneity index to the untreated ipsilateral lung lobes. The procedure may be performed under deep sedation or preferably under general anesthesia. After positioning of the BTVA catheter and occlusion of the target segment by the occlusion balloon, heated water vapor is delivered in a predetermined specified time according to the vapor dose. After the procedure, patients should be strictly monitored to proactively detect symptoms of localized inflammatory reaction that may temporarily worsen the clinical status of the patient and to detect complications. As the data are still very limited, BTVA should be performed within clinical trials or comprehensive registries where the product is commercially available.
经支气管热蒸汽消融（BTVA）是一种内镜下肺减容术（ELVR）技术，旨在减少晚期肺气肿患者的过度充气，改善呼吸力学。通过有针对性的节段性蒸汽消融，炎症反应导致最严重的肺气肿节段的组织和体积减少。到目前为止，BTVA 已在几项单臂试验和 1 项多中心随机对照试验中得到证实，可改善上叶为主型肺气肿患者的肺功能、运动能力和生活质量，而与侧支通气无关。在这篇综述中，我们强调了这种 ELVR 方法的实际方面。上叶为主型肺气肿、用力呼气量 1 秒（FEV1）在预测值的 20%至 45%之间、残气量（RV）>预测值的 175%、一氧化碳弥散量（DLCO）≥预测值的 20%的患者可考虑接受 BTVA 治疗。在手术前，特殊软件可协助识别目标节段，这些节段具有最高的肺气肿指数、体积和与未治疗的同侧肺叶相比具有最高的异质性指数。该程序可以在深度镇静下或最好在全身麻醉下进行。BTVA 导管定位并通过闭塞球囊闭塞目标节段后，根据蒸汽剂量在预定的指定时间内输送加热蒸汽。手术后，应严格监测患者，以主动发现局部炎症反应的症状，这些症状可能会暂时使患者的临床状况恶化，并发现并发症。由于数据仍然非常有限，BTVA 应在临床试验或有商业产品的综合登记处进行。
