Ensarioğlu Kerem, Kurt Bahar
Clinic of Pulmonary Diseases, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, Türkiye.
Clinic of Pulmonary Diseases, Ankara Etlik State Hospital, Ankara, Türkiye.
Tuberk Toraks. 2024 Mar;72(1):37-47. doi: 10.5578/tt.202401834.
Chronic obstructive pulmonary disease (COPD) is a commonly seen, preventable, and treatable disease with permanent respiratory symptoms and air entrapment that is caused by particle exposure. In case of limited response to traditional treatment protocols, lung volume reduction may be performed in patients with emphysema dominant patterns. In this study, long term follow-up results of the patients who had been operated on by minimal invasive bronchoscopic lung volume reduction surgery by coil placement were reported.
Records of the patients operated on by coil placement were retrospectively investigated, and pulmonary function test (PFT), echocardiography (ECHO), six-minute walking test (6MWT), tomography images, ventilation scintigraphy, and clinical summaries were evaluated. Out of 34 initial candidates, 18 patients were included in the study. Wilcoxon signed-rank test and Spearman's rho were utilized to compare interventions and follow-up testing.
The average age of 18 patients was 62 (50-74) years, and except for one patient, all were males (n= 17). Fifteen patients were operated bilaterally, and the rest were unilaterally operated, with an average of 10 coils placed per coil placement. An average of 90 days was between bronchoscopic coil placement, with a follow-up duration of 45 days in between. Mean total follow-up duration was 794 (± 424) days. Pneumonia and pneumonitis were seen in 33% of patients within the first month. Mortality from respiratory causes was found to be 11%, while mortality from all causes was found to be 22%. Statistical difference was observed regarding 6MWT after bronchoscopic volume reduction when compared the initial preoperative values. However, this difference was later lost statistically at the second follow-up performed after the completion of both sides. A benefit in improved resting saturation was observed after the second procedure, which was not evident after unilateral intervention. However, similiar to 6MWT, this benefit was lost at the second follow-up, with resting saturation instead being effected negatively. No difference was observed in PFT results; however, a correlation was seen between FEV1 and walking distance. No specific correlation had been seen in the ECHO evaluation.
Benefits regarding 6MWT and resting saturation were observed in patients undergoing minimal invasive bronchoscopic lung volume reduction surgery with coils. This benefit was evident in the short term but was lost as the follow-up duration increased. A relatively high morbidity and mortality rate was also present, further stating the risky nature of pulmonary intervention, even minimally invasive procedures, on patients with COPD.
慢性阻塞性肺疾病（COPD）是一种常见的、可预防和可治疗的疾病，具有永久性呼吸症状和因接触颗粒物导致的气体潴留。在对传统治疗方案反应有限的情况下，对于以肺气肿为主型的患者可进行肺减容术。本研究报告了接受经支气管镜微创肺减容术（通过放置线圈）治疗的患者的长期随访结果。
回顾性研究接受线圈置入手术患者的记录，并评估肺功能测试（PFT）、超声心动图（ECHO）、六分钟步行试验（6MWT）、断层扫描图像、通气闪烁扫描及临床总结。在34名初始候选患者中，18名患者纳入研究。采用Wilcoxon符号秩检验和Spearman秩相关系数来比较干预措施和随访测试结果。
18名患者的平均年龄为62（50 - 74）岁，除1名患者外，均为男性（n = 17）。15名患者接受双侧手术，其余患者接受单侧手术，每次线圈置入平均放置10个线圈。两次支气管镜线圈置入的平均间隔时间为90天，两次置入之间的随访时间为45天。平均总随访时间为794（±424）天。33%的患者在第一个月内出现肺炎和肺炎性病变。呼吸原因导致的死亡率为11%，全因死亡率为22%。与术前初始值相比，支气管镜肺减容术后6MWT有统计学差异。然而，在双侧手术完成后的第二次随访中，这种差异在统计学上消失。第二次手术后观察到静息饱和度有所改善，单侧干预后不明显。然而，与6MWT情况类似，这种益处在第二次随访时消失，静息饱和度反而受到负面影响。PFT结果无差异；然而，FEV1与步行距离之间存在相关性。ECHO评估未发现特定相关性。
接受经支气管镜微创肺减容术（通过放置线圈）的患者在6MWT和静息饱和度方面有获益。这种益处在短期内明显，但随着随访时间延长而消失。还存在相对较高的发病率和死亡率，进一步说明对COPD患者进行肺部干预（即使是微创手术）具有风险性。
