Yang Han, Chen Si, Sun Jiayuan, Herth Felix J F
Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.
Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.
Chin Med J Pulm Crit Care Med. 2024 Sep 17;2(3):171-181. doi: 10.1016/j.pccm.2024.08.001. eCollection 2024 Sep.
Chronic inflammatory airway diseases, such as chronic bronchitis, chronic obstructive pulmonary disease, emphysema, and bronchial asthma, pose significant healthcare challenges. Interventional treatments offer promise as valuable complements to the optimal medical therapy recommended by the Global Initiative for Chronic Obstructive Lung Disease guideline and the Global Initiative for Asthma guideline. By directly accessing the airways, these minimally invasive procedures enable precise interventions. They encompass a wide range of techniques including bronchial thermoplasty and targeted lung denervation for both chronic obstructive pulmonary disease and severe asthma, bronchoscopic lung volume reduction (including the use of endobronchial valves, coils, and bronchoscopic thermal vapor ablation), airway bypass and peripheral stent placement for emphysema, bronchial rheoplasty and spray cryotherapy for chronic bronchitis, and other emerging methods. These interventional treatments aim to improve patients' symptoms by reducing lung volume, alleviating hyperinflation, eliminating vagal innervation, disrupting hyperplastic goblet cells and thus reducing excessive mucus secretion, and weakening submucosal smooth muscles. This review highlights the potential advantages of interventional treatments for chronic inflammatory airway diseases and discusses relevant techniques tailored to specific disease subtypes. The overall aim is to assist interventional pulmonologists in selecting the most appropriate techniques for individual patients.
慢性炎症性气道疾病，如慢性支气管炎、慢性阻塞性肺疾病、肺气肿和支气管哮喘，给医疗保健带来了重大挑战。介入治疗有望成为慢性阻塞性肺疾病全球倡议指南和哮喘全球倡议指南所推荐的最佳药物治疗的宝贵补充。通过直接进入气道，这些微创手术能够进行精确干预。它们涵盖了广泛的技术，包括用于慢性阻塞性肺疾病和重度哮喘的支气管热成形术和靶向肺去神经支配、支气管镜下肺减容术（包括使用支气管内瓣膜、线圈和支气管镜热蒸汽消融）、用于肺气肿的气道旁路和外周支架置入、用于慢性支气管炎的支气管成形术和喷雾冷冻疗法，以及其他新兴方法。这些介入治疗旨在通过减少肺容积、减轻肺过度充气、消除迷走神经支配、破坏增生的杯状细胞从而减少过多黏液分泌，以及削弱黏膜下平滑肌来改善患者症状。本综述强调了介入治疗对慢性炎症性气道疾病的潜在优势，并讨论了针对特定疾病亚型的相关技术。总体目标是帮助介入肺科医生为个体患者选择最合适的技术。
