Department of Pathology, Anatomy, and Laboratory Medicine (PALM), West Virginia University School of Medicine, Morgantown, West Virginia, USA.
West Liberty University, Wheeling, West Virginia, USA.
Clin Respir J. 2024 Jan;18(1):e13721. doi: 10.1111/crj.13721.
Bronchoalveolar lavage (BAL) is frequently used in pulmonary medicine though it requires further optimization. Practical obstacles such as patient safety and procedural limitation have to date precluded large, controlled trials aimed at standardization of BAL procedure. Indeed, BAL guidelines are based on observational data. Innovative research methods are necessary to advance the clinical practice of BAL.
In our study, we evaluated the effect of injecting a gelatinized barium solution into different lobes and segments of cadaveric lungs. As the technique requires an irreversible injection into lung airspaces, it is not suitable for in vivo purposes. We measured the volume returned from BAL as well as the distribution of BAL injection via dissection. Segmental anatomic orientation was compared to a radiologist's impression of plain film radiographs taken of injected lungs.
Mean injected volume distributions were greatest in the upper lobes and lowest in the lower lobes; mean ratios of injected volume distribution to lung lobe volume also followed this trend. Cannulated bronchi orders favored lower branches in the upper lobe and higher branches in the lower lobes. Segmental anatomy varied by the lung lobe injected and was most varied in the lower lobes.
This novel gelatinized-barium injection technique provides a minimally complex method to yield clinically meaningful feedback on the performance of BAL. The technique is also adaptable to study of procedural parameters in the context of variable lung anatomies and pathologies.
支气管肺泡灌洗（BAL）在肺部医学中经常使用，但需要进一步优化。迄今为止，由于患者安全和程序限制等实际障碍，还无法进行旨在标准化 BAL 程序的大型对照试验。实际上，BAL 指南是基于观察性数据制定的。需要创新的研究方法来推进 BAL 的临床实践。
在我们的研究中，我们评估了将胶凝钡溶液注入尸体肺的不同叶和段的效果。由于该技术需要将不可逆地将溶液注入肺气道，因此不适合活体目的。我们通过解剖测量了 BAL 回抽量以及 BAL 注射的分布。节段解剖方位与放射科医生对注入肺部拍摄的平片印象进行了比较。
平均注入体积分布在上叶最大，在下叶最小；注入体积分布与肺叶体积的平均比值也呈此趋势。套入的支气管顺序在上叶中偏向于较低的分支，在下叶中偏向于较高的分支。节段解剖因注入的肺叶而异，在下部肺叶中变化最大。
这种新型胶凝钡注射技术为 BAL 的性能提供了一种简单而有意义的反馈方法。该技术还可适应研究不同肺解剖结构和病理下程序参数的变化。
