Fiorelli Alfonso, D'Andrilli Antonio, Bezzi Michela, Ibrahim Mohsen, Anile Marco, Diso Daniele, Cusumano Giacomo, Terminella Alberto, Luzzi Valentina, Innocenti Margherita, Novali Mauro, Carelli Emanuele, Freda Chiara, Natale Giovanni, Peritore Valentina, Poggi Camilla, Failla Giuseppe, Basile Marco, Mazzucca Emilia, Conforti Serena, Serra Nicola, Torre Massimo, Venuta Federico, Rendina Erino Angelo, Santini Mario, Andreetti Claudio
Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy.
Thoracic Surgery Unit, Università La Sapienza, Sant'Andrea Hospital, Rome, Italy.
J Thorac Dis. 2018 Oct;10(Suppl 27):S3315-S3325. doi: 10.21037/jtd.2018.06.69.
Despite bronchoscopic lung volume reduction (BLVR) with valves is a minimally invasive treatment for emphysema, it can associate with some complications. We aimed at evaluating the rate and type of complications related to valve treatment and their impact on clinical outcomes.
It is a retrospective multicenter study including all consecutive patients with severe heterogeneous emphysema undergoing BLVR with endobronchial valve treatment and developed any complications related to this procedure. The type of complication, the time of onset, the treatment required and the out-come were evaluated. Response to treatment was assessed according to the minimal clinically important difference (MCID) as follows: an improvement of ≥15% in forced expiratory volume in one second (FEV); of -8% in residual volume (RV); of ≥26 m in 6-minnute walking distance (6MWD); and of ≥4 points on the St. George's Respiratory Questionnaire (SGRQ). Target lobe volume reduction (TLVR) ≥350 mL was considered significant.
One hundred and seven out of 423 (25.3%) treated patients had complications related to valve treatment including pneumothorax (17.3%); pneumonia (1.7%), chronic obstructive pulmonary disease (COPD) exacerbation (0.9%), respiratory failure (1.4%), valve migration (2.1%), and hemoptysis (1.9%). In all cases complications resolved with appropriate treatment including removal of valves in 21/107 cases (19.6%). Patients with TLVR ≥350 mL (n=64) those <350 mL (n=43) had a statistically significant higher improvement in FEV (19.0%±3.9% 3.0%±0.9%; P=0.0003); in RV (-10.0%±4.8% -4.0%±2.9%; P=0.002); in 6MWD (33.0±19.0 12.0±6.3 metres; P=0.001); and in SGRQ (-15.0±2.9 -8.0±3.5 points; P=0.01). Only patients with TLVR ≥350 mL met or exceeded the MCID cut-off criteria for FEV (19.0%±3.9%), RV (-10.0%±4.8%), 6MWT (33.0±19.0 metres), and SGQR (-15.0±2.9 points). Five patients (1.2%) died during follow-up for causes not related to valves treatment neither to any of the complications described.
Valve treatment is a safe and reversible procedure. The presence of complications seems not to have a significant impact on clinical outcome in patients with lobar atelectasis. Due to poor clinical conditions and possible complications, BLVR should be performed in high volume centers with a multidisciplinary approach.
尽管采用瓣膜的支气管镜肺减容术（BLVR）是治疗肺气肿的一种微创治疗方法，但它可能会伴有一些并发症。我们旨在评估与瓣膜治疗相关的并发症的发生率和类型及其对临床结局的影响。
这是一项回顾性多中心研究，纳入了所有连续接受采用支气管内瓣膜治疗的重度异质性肺气肿患者，且这些患者出现了与该手术相关的任何并发症。评估并发症的类型、发病时间、所需治疗及结局。根据最小临床重要差异（MCID）评估治疗反应如下：一秒用力呼气容积（FEV）改善≥15%；残气量（RV）改善-8%；6分钟步行距离（6MWD）增加≥26米；圣乔治呼吸问卷（SGRQ）得分改善≥4分。目标肺叶容积减少（TLVR）≥350 mL被认为是显著的。
423例接受治疗的患者中有107例（25.3%）出现了与瓣膜治疗相关的并发症，包括气胸（17.3%）；肺炎（1.7%），慢性阻塞性肺疾病（COPD）加重（0.9%），呼吸衰竭（1.4%），瓣膜移位（2.1%）和咯血（1.9%）。在所有病例中，通过适当治疗并发症均得到解决，其中21/107例（19.6%）患者需要取出瓣膜。TLVR≥350 mL的患者（n = 64）与TLVR<350 mL的患者（n = 43）相比，FEV改善更显著（19.0%±3.9%对3.0%±0.9%；P = 0.0003）；RV改善更显著（-10.0%±4.8%对-4.0%±2.9%；P = 0.002）；6MWD增加更显著（33.0±19.0对12.0±6.3米；P = 0.001）；SGRQ得分改善更显著（-15.0±2.9对-8.0±3.5分；P = 0.01）。只有TLVR≥350 mL的患者达到或超过了FEV（19.0%±3.9%）、RV（-10.0%±4.8%）、6MWT（33.0±19.0米）和SGQR（-15.0±2.9分）的MCID截止标准。5例患者（1.2%）在随访期间死亡，死亡原因与瓣膜治疗及上述任何并发症均无关。
瓣膜治疗是一种安全且可逆的手术。并发症的出现似乎对肺叶肺不张患者的临床结局没有显著影响。由于临床情况较差且可能出现并发症，BLVR应在具备多学科方法的高容量中心进行。
