Yamamoto Shota, Horita Nobuyuki, Imai Ryosuke, Niitsu Takayuki
Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.
Chemotherapy Center, Yokohama City University Hospital, Yokohama, Japan.
Lung. 2025 Jan 6;203(1):22. doi: 10.1007/s00408-024-00777-0.
Along with lung volume reduction surgery (LVRS), bronchoscopic lung volume reduction is a treatment option for end-stage emphysema. However, comparisons among interventions remain insufficient.
We searched on PubMed, CENTRAL, Embase, and Web of Science. We included randomized controlled trials with outcomes measuring mid-term mortality within 6 months, changes in forced expiratory volume in one second (FEV), St. George's Respiratory Questionnaire (SGRQ), six-minute walk distance (6MWD) from baseline, adverse event related to procedures, and long-term mortality within 5 years. Bayesian network meta-analysis was performed. The certainty was assessed by CINeMA.
Twenty-five randomized controlled trials involving 4,283 patients were included, identifying seven types of procedures and standard of care. Mid-term mortality increased in LVRS and endobronchial valve (EBV) (LVRS, risk ratio [RR] 3.26, 95% CrI 1.98-6.21, low certainty; EBV, RR 2.06 95% CrI 1.07-4.36, moderate certainty). LVRS showed the largest improvements: change in FEV (187.2 mL, 95% CrI 166.4-209.6), 6MWD (42.2 m, 95% CrI 33.2-50.5), and SGRQ (- 13.29 points, 95% CrI - 27.25-0.75). Among bronchoscopic procedures, high efficacy was noted in EBV and endobronchial coil (EBC) for FEV changes (EBV, 111.8 mL, 95% CrI 92.2-136.2; EBC, 74.1 mL, 95% CrI 47.6-101.7). Pneumothorax increased in these two procedures (EBV, RR 12.75, 95% CrI 5.52-35.48; EBC, RR 4.95, 95% CrI 1.12-40.90).
LVRS offers high efficacies but is accompanied by increased mid-term mortality. EBV and EBC also showed effectiveness; however, they increased pneumothorax, and EBV slightly increased mortality. For accurate assessment, long-term survival data of BLVR are needed.
除肺减容手术（LVRS）外，支气管镜肺减容术也是终末期肺气肿的一种治疗选择。然而，各干预措施之间的比较仍不充分。
我们检索了PubMed、CENTRAL、Embase和Web of Science。纳入了随机对照试验，其结局指标包括6个月内的中期死亡率、一秒用力呼气量（FEV）的变化、圣乔治呼吸问卷（SGRQ）、自基线起的6分钟步行距离（6MWD）、与手术相关的不良事件以及5年内的长期死亡率。进行了贝叶斯网络荟萃分析。采用CINeMA评估证据确定性。
纳入了25项涉及4283例患者的随机对照试验，确定了7种手术方式和标准治疗。LVRS和支气管内瓣膜（EBV）的中期死亡率增加（LVRS，风险比[RR] 3.26，95%可信区间[CrI] 1.98 - 6.21，低确定性；EBV，RR 2.06，95% CrI 1.07 - 4.36，中等确定性）。LVRS显示出最大的改善：FEV变化（187.2 mL，95% CrI 166.4 - 209.6）、6MWD（42.2 m，95% CrI 33.2 - 50.5）和SGRQ（-13.29分，95% CrI -27.25 - 0.75）。在支气管镜手术中，EBV和支气管内线圈（EBC）在FEV变化方面显示出高效性（EBV，111.8 mL，95% CrI 92.2 - 136.2；EBC，74.1 mL，95% CrI 47.6 - 101.7）。这两种手术气胸发生率增加（EBV，RR 12.75，95% CrI 5.52 - 35.48；EBC，RR 4.95，95% CrI 1.12 - 40.90）。
LVRS疗效高，但伴有中期死亡率增加。EBV和EBC也显示出有效性；然而，它们增加了气胸发生率，且EBV略微增加了死亡率。为进行准确评估，需要支气管镜肺减容术的长期生存数据。
