Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Röntgenstr. 1, 69126 Heidelberg, Germany.
Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.
Ther Adv Respir Dis. 2019 Jan-Dec;13:1753466619835494. doi: 10.1177/1753466619835494.
Endoscopic and surgical interventions may be beneficial for selected patients with emphysema. Rates of treatment failure decrease when the predictors for successful therapy are known. The aim of the study was to evaluate the number of patients with severe emphysema who were not eligible for any intervention, and the reasons for their exclusion.
The study was a retrospective analysis of 231 consecutive patients with advanced emphysema who were considered for interventional therapy in 2016 at the Thoraxklinik, Heidelberg, Germany. The reasons for not receiving valve or coil therapy were assessed for all patients who did not receive any therapy.
Of the 231 patients, 50% received an interventional therapy for lung volume reduction (LVR) (82% valve therapy, 6% coil therapy, 4.3% polymeric LVR or bronchial thermal vapour ablation, 4.3% total lung denervation, and 3.4% lung volume reduction surgery [LVRS]). A total of 115 patients did not undergo LVR. Out of these, valve or coil therapy was not performed due to one or more of the following reasons: incomplete fissure in 37% and 0%; missing target lobe in 31% and 30%; personal decision in 18% and 28%; pulmonary function test results in 8% and 15%; ventilatory failure in 4% and 4%; missing optimal standard medical care and/or continued nicotine abuse in 4% and 3%; general condition too good in less than 1% and 3%; cardiovascular comorbidities in 0% and 3%; age of patient in 0% and less than 1%. Both techniques were not performed due to one or more of the following reasons: solitary pulmonary nodule(s)/consolidation in 27%; bronchopathy in 7%; neoplasia in 2%; destroyed lung in 2%; prior LVRS in less than 1%.
The main reason for not placing valves was an incomplete fissure and for coils a missing target lobe. Numerous additional contraindications that may exclude a patient from interventional emphysema therapy should be respected.
对于特定的肺气肿患者，内镜和手术干预可能是有益的。当已知治疗成功的预测因素时，治疗失败的发生率会降低。本研究的目的是评估不适合任何干预的严重肺气肿患者的数量，并确定其排除原因。
本研究回顾性分析了 2016 年德国海德堡胸科诊所 231 例接受介入治疗的晚期肺气肿患者。评估了所有未接受任何治疗的患者不接受瓣膜或线圈治疗的原因。
231 例患者中，50%接受了肺减容术（LVR）介入治疗（82%瓣膜治疗、6%线圈治疗、4.3%聚合物 LVR 或支气管热蒸汽消融、4.3%全肺去神经支配和 3.4%肺减容手术[LVRS]）。共有 115 例患者未接受 LVR。其中，由于以下一个或多个原因未进行瓣膜或线圈治疗：37%和 0%存在不完全裂；31%和 30%存在缺失目标肺叶；18%和 28%为个人决定；8%和 15%为肺功能检查结果；4%和 4%为通气衰竭；4%和 3%为缺失最佳标准医疗护理和/或持续尼古丁滥用；不到 1%和 3%为一般情况较好；0%和 3%为心血管合并症；0%和小于 1%为患者年龄。由于以下一个或多个原因，两种技术均未进行：27%为孤立性肺结节/实变；7%为支气管病；2%为肿瘤；2%为肺破坏；不到 1%为既往 LVRS。
未放置瓣膜的主要原因是不完全裂，未放置线圈的主要原因是缺失目标肺叶。应尊重可能将患者排除在介入性肺气肿治疗之外的许多其他禁忌症。
