Department of Thoracic Oncology, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Department of Pulmonary Diseases, CHU de Québec, Quebec, Québec, Canada.
Respiration. 2024;103(9):544-562. doi: 10.1159/000539573. Epub 2024 Jun 13.
Persistent air leak (PAL) is associated with prolonged hospitalization, high morbidity and increased treatment costs. Conservative treatment consists of observation, chest tube drainage, and pleurodesis. Guidelines recommend surgical evaluation if air leak does not respond after 3-5 days. One-way endobronchial valves (EBV) have been proposed as a treatment option for patients with PAL in which surgical treatment is not feasible, high risk or has failed. We aimed to provide a comprehensive overview of reported EBV use for PAL and issue best practice recommendations based on multicenter experience.
We conducted a retrospective observational case-series study at four different European academic hospitals and provided best practice recommendations based on our experience. A systematic literature review was performed to summarize the current knowledge on EBV in PAL.
We enrolled 66 patients, male (66.7%), median age 59.5 years. The most common underlying lung disease was chronic obstructive pulmonary disease (39.4%) and lung cancer (33.3%). The median time between pneumothorax and valve placement was 24.5 days (interquartile range: 14.0-54.3). Air leak resolved in 40/66 patients (60.6%) within 30 days after EBV treatment. Concerning safety outcome, no procedure-related mortality was reported and complication rate was low (6.1%). Five patients (7.6%) died in the first 30 days after intervention.
EBV placement is a treatment option in patients with PAL. In this multicenter case-series of high-risk patients not eligible for lung surgery, we show that EBV placement resulted in air leak resolution in 6 out of 10 patients with a low complication rate. Considering the minimally invasive nature of EBV to treat PAL as opposed to surgery, further research should investigate if EBV treatment should be expanded in low to intermediate risk PAL patients.
持续性气胸（PAL）与住院时间延长、高发病率和增加治疗成本有关。保守治疗包括观察、胸腔引流和胸膜固定术。如果气胸在 3-5 天后仍未得到缓解，指南建议进行手术评估。单向支气管内活瓣（EBV）已被提议作为不能进行手术、手术风险高或手术失败的 PAL 患者的一种治疗选择。我们旨在提供一份关于 EBV 治疗 PAL 的报告概述，并根据多中心经验提出最佳实践建议。
我们在欧洲四家不同的学术医院进行了回顾性观察性病例系列研究，并根据我们的经验提供了最佳实践建议。我们还进行了系统的文献综述，以总结 EBV 在 PAL 中的现有知识。
我们共纳入 66 例患者，其中男性（66.7%），中位年龄 59.5 岁。最常见的基础肺部疾病是慢性阻塞性肺疾病（39.4%）和肺癌（33.3%）。气胸与瓣膜放置之间的中位时间为 24.5 天（四分位距：14.0-54.3）。66 例患者中有 40 例（60.6%）在 EBV 治疗后 30 天内气胸得到缓解。就安全性结果而言，没有与程序相关的死亡报告，并发症发生率低（6.1%）。5 例（7.6%）患者在干预后 30 天内死亡。
在不适合肺手术的高危 PAL 患者中，放置 EBV 是一种治疗选择。在这项多中心高危病例系列研究中，我们发现 10 例患者中有 6 例通过 EBV 放置使气胸得到缓解，并发症发生率低。考虑到 EBV 治疗 PAL 的微创性，与手术相比，进一步的研究应探讨是否应将 EBV 治疗扩展到低危和中危 PAL 患者。
