Majid Adnan, Kheir Fayez, Alape Daniel, Chee Alex, Parikh Mihir, DeVore Lauri, Agnew Alexis, Gangadharan Sidhu
Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Division of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, LA.
J Bronchology Interv Pulmonol. 2020 Apr;27(2):128-134. doi: 10.1097/LBR.0000000000000617.
In patients with severe emphysema and complete fissures, bronchoscopic lung volume reduction with valves reduces target lobe volume providing improvement in respiratory symptoms, lung function, quality of life, and exercise capacity. It is estimated that up to 88% of patients with emphysema have at least 1 incomplete interlobar fissure. The aim of this study was to evaluate the feasibility of creating a complete fissure with stapling via minimally invasive video-assisted thoracoscopic surgery (VATS) followed by bronchoscopic valve placement to induce lobar collapse in a swine model.
Chest computed tomography (CT) scans were performed on 2 swine and at least 1 target incomplete fissure was identified. Both swine underwent VATS to complete the target fissure using a surgical stapler, followed by bronchoscopic placement of the Spiration endobronchial valves. A chest CT scan was performed immediately postprocedure. Follow-up bronchoscopy and CT scans were performed 2 weeks after the initial procedure prior to sacrifice.
Successful fissure completion was accomplished using VATS and confirmed at postmortem explanted lung gross examination. Flexible bronchoscopy 2 weeks following valve placement showed proper positioning of the valves. Effectiveness of combined procedures was confirmed by a chest CT scan that showed complete atelectasis of the target lobe at 2-week follow-up. There was no perioperative or postoperative morbidity or mortality.
Combined minimally invasive VATS fissure stapling with bronchoscopic valve placement to induce lobar atelectasis appears safe and feasible in the swine model. Future research in humans using a combined procedure is needed to confirm safety and clinical efficacy.
在重度肺气肿且肺裂完整的患者中，使用瓣膜进行支气管镜下肺减容可减少目标肺叶体积，从而改善呼吸症状、肺功能、生活质量和运动能力。据估计，高达88%的肺气肿患者至少有1条肺叶间裂不完整。本研究的目的是评估在猪模型中，通过微创电视辅助胸腔镜手术（VATS）使用吻合器创建完整肺裂，随后放置支气管镜瓣膜以诱导肺叶萎陷的可行性。
对2头猪进行胸部计算机断层扫描（CT），确定至少1条目标不完整肺裂。两头猪均接受VATS，使用手术吻合器完成目标肺裂，随后支气管镜下放置Spiration支气管内瓣膜。术后立即进行胸部CT扫描。在初次手术后2周，处死动物前进行随访支气管镜检查和CT扫描。
通过VATS成功完成肺裂创建，并在尸检离体肺大体检查中得到证实。瓣膜放置2周后的柔性支气管镜检查显示瓣膜位置正确。胸部CT扫描证实联合手术的有效性，在2周随访时显示目标肺叶完全肺不张。无围手术期或术后发病率或死亡率。
在猪模型中，联合微创VATS肺裂吻合术与支气管镜瓣膜放置以诱导肺叶肺不张似乎是安全可行的。需要在人类中进行进一步研究以证实联合手术的安全性和临床疗效。
