经皮肺大疱穿刺术行疱内粘连固定术（IBAP）：一种治疗巨大肺大疱（GPB）的手术替代方法。

Intrabullous Adhesion Pexia (IBAP) by Percutaneous Pulmonary Bulla Centesis: An Alternative for the Surgical Treatment of Giant Pulmonary Bulla (GPB).

作者信息

Li Wei-Liang, Li Yong-Hua, Yang Yu-Bo, Lv Li-Hui

机构信息

Department of Respiratory and Critical Care Medicine, Mingzhou Hospital, Zhejiang University, No. 168 West Taian Road, Ningbo, Zhejiang 315199, China.

Department of Respiratory and Critical Care Medicine, Donghai Hospital, Ningbo University, No. 377 Zhongshan East Road, Ningbo 315040, China.

出版信息

Can Respir J. 2018 Oct 23;2018:5806834. doi: 10.1155/2018/5806834. eCollection 2018.

DOI:10.1155/2018/5806834

PMID:30425754

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6218743/

Abstract

BACKGROUND AND OBJECTIVE

Most patients with giant pulmonary bulla (GPB) are treated by surgery; however, there is a subset for whom surgery is not a viable option, such as those with contraindications, or those unwilling to undergo operation. Therefore, an alternative minimally invasive method is desired for this subpopulation. The aim of this study was to explore an alternative procedure for treating GPB.

METHODS

This was a prospective, nonrandomized, single-arm, unblinded study evaluating the efficacy and safety of intrabulla adhesion pexia (IBAP) procedure in GPB patients. The study was conducted between December 2004 and April 2017.

RESULTS

There were 38 cases in 36 patients (33 males and 3 females) with the target GPB cavities varying in size (range, 10 cm × 7 cm × 5 cm to 15 cm × 8 cm × 30 cm (anteroposterior diameter × medial-lateral diameter × superoinferior diameter)). After IBAP treatment, the closure ratio of GPB in one month was 86.84% (33/38), while the dyspnea index significantly decreased from 4.11 ± 1.11 to 2.24 ± 1.15 ( < 0.01). In addition, the mean FEV1 (L) increased from 1.06 ± 0.73 to 1.57 ± 1.13 ( < 0.01), while RV (L) decreased from 2.77 ± 0.54 to 2.36 ± 0.38 ( < 0.01) and TLC (L) decreased from 6.46 ± 1.21 to 5.86 ± 1.08 ( < 0.01). Moreover, PaO (mmHg) increased from 52.18 ± 8.31 to 68.29 ± 12.34, while the 6 MWD increased by 129.36% from 131.58 ± 105.24 to 301.79 ± 197.90 ( < 0.01). Collectively, these data indicated significant improvement in pulmonary function and exercise tolerance after IBAP treatment. Furthermore, no deaths occurred during IBAP treatment, and no cases of aggravated GPB relapse were reported during the 12-month follow-up period.

CONCLUSIONS

IBAP is a promising strategy for the treatment of GPB. Our findings demonstrated that IBAP had a noteworthy therapeutic effect, desirable safety, and ideal long-term efficacy for GPB.

摘要

背景与目的

大多数巨大肺大疱（GPB）患者接受手术治疗；然而，有一部分患者手术并非可行选择，例如存在禁忌证的患者，或不愿接受手术的患者。因此，需要为这一亚群寻找一种替代性的微创方法。本研究的目的是探索一种治疗GPB的替代手术。

方法

这是一项前瞻性、非随机、单臂、非盲研究，评估肺大疱内粘连固定术（IBAP）治疗GPB患者的疗效和安全性。研究于2004年12月至2017年4月进行。

结果

36例患者共38个病例（男性33例，女性3例），目标GPB空洞大小各异（范围为10 cm×7 cm×5 cm至15 cm×8 cm×30 cm（前后径×内外径×上下径））。IBAP治疗后，1个月时GPB的闭合率为86.84%（33/38），而呼吸困难指数从4.11±1.11显著降至2.24±1.15（P<0.01）。此外，平均第一秒用力呼气容积（FEV1，L）从1.06±0.73增至1.57±1.13（P<0.01），残气量（RV，L）从2.77±0.54降至2.36±0.38（P<0.01），肺总量（TLC，L）从6.46±1.21降至5.86±1.08（P<0.01）。而且，动脉血氧分压（PaO，mmHg）从52.18±8.31升至68.29±12.34，6分钟步行距离（6 MWD）从131.58±105.24增加129.36%至301.79±197.90（P<0.01）。总体而言，这些数据表明IBAP治疗后肺功能和运动耐力有显著改善。此外，IBAP治疗期间无死亡发生，12个月随访期内未报告GPB复发加重病例。