Kouritas Vasileios, Milton Richard, Kefaloyannis Emmanouel, Papagiannopoulos Kostas, Brunelli Allesandro, Dimov Doytchin, Karthik Sishik, Hardy Andrew, Tcherveniakov Peter, Chaudhuri Nilanjan
Department of Thoracic Surgery, St James's University Hospital, Leeds, UK.
Department of Respiratory Diseases, St James's University Hospital, Leeds, UK.
Clin Med Insights Circ Respir Pulm Med. 2019 Jun 19;13:1179548419852063. doi: 10.1177/1179548419852063. eCollection 2019.
The emphysema interventional treatment involves mainly lung volume reduction surgery (LVRS) and endobronchial valve (EBV) implantation. Few institutes discuss these cases at a dedicated emphysema multidisciplinary team (MDT) meeting.
To investigate the impact of a newly established dedicated emphysema MDT meeting on the interventional treatment of such patients.
During a study period of 4 years, the outcome of 44 patients who underwent intervention according to the proposal of the emphysema MDT (group A) was compared with the outcome of 44 propensity score matched patients (group B) treated without the emphysema MDT proposal.
More LVRS and less EBV insertions were performed in group A (=.009). In group B, the interventions were performed sooner than in group A (=.003). Postoperative overall morbidity and length of in-hospital stay were similar in the 2 groups (=.918 and .758, respectively). Improvement of breathing ability was reported in more patients from group A (=.012). In group B, the total number of re-interventions was higher (=.001) and the time to re-intervention had the tendency to be less (=.069). Survival was similar between the 2 groups (=.884). Intervention without discussion at the MDT and EBV as initial intervention was an independent predictor of re-intervention.
Interventional treatment for patients with chronic obstructive pulmonary disease (COPD) after discussion at a dedicated MDT involved more LVRS performed, required fewer interventions for their disease, and had longer re-intervention-free intervals and better breathing improvement.
肺气肿的介入治疗主要包括肺减容手术（LVRS）和支气管内瓣膜（EBV）植入。很少有机构在专门的肺气肿多学科团队（MDT）会议上讨论这些病例。
研究新设立的专门的肺气肿MDT会议对这类患者介入治疗的影响。
在4年的研究期间，将44例根据肺气肿MDT建议接受干预的患者（A组）的结果与44例倾向评分匹配但未根据肺气肿MDT建议接受治疗的患者（B组）的结果进行比较。
A组进行的LVRS更多，EBV植入更少（P = 0.009）。B组的干预比A组更早进行（P = 0.003）。两组术后总体发病率和住院时间相似（分别为P = 0.918和0.758）。A组更多患者报告呼吸能力得到改善（P = 0.012）。B组再次干预的总数更高（P = 0.001），再次干预的时间倾向于更短（P = 0.069）。两组生存率相似（P = 0.884）。在MDT会议上未经讨论的干预以及以EBV作为初始干预是再次干预的独立预测因素。
在专门的MDT会议上讨论后，慢性阻塞性肺疾病（COPD）患者的介入治疗包括更多的LVRS，所需的疾病干预更少，无再次干预间隔时间更长，呼吸改善更好。
