Ouyang Lecong, Zhang Weidong, Wang Zeqiang
Department of Respiratory and Critical Care Medicine, Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China.
Medicine (Baltimore). 2025 Jun 20;104(25):e43003. doi: 10.1097/MD.0000000000043003.
Giant emphysematous bullae (GEB) in chronic obstructive pulmonary disease cause severe respiratory compromise. While surgical resection is standard, bronchoscopic volume reduction is crucial for surgically ineligible patients. Accurate target bronchus identification remains challenging with conventional imaging.
A 67-year-old male with chronic obstructive pulmonary disease and right lung GEB presented with severe dyspnea (modified Medical Research Council score 4), hypercapnia (partial pressure of carbon dioxide: 45 mm Hg), and markedly limited exercise tolerance (6-minute walk distance: 62 m). He required home noninvasive ventilation and was deemed unfit for surgery due to critically impaired lung function (Forced expiratory volume in 1 second: 0.36 L, 12.2% predicted).
Preoperative high-resolution computed tomography (CT) and 3D reconstruction localized the target bronchus to the right middle lobe. However, percutaneous aspiration and drug injection via drainage tube revealed misalignment, prompting reidentification of the target bronchus in the posterior segment of the right upper lobe.
CT-guided percutaneous GEB volume reduction was performed, involving air extraction and intrabullous injection of erythromycin lactobionate. Subsequent selective bronchial occlusion of the posterior right upper lobe segment via bronchoscopic autologous blood and thrombin injection was conducted. Continuous negative-pressure drainage was maintained post-procedure.
Follow-up CT at 6 months confirmed complete GEB closure. Dyspnea improved significantly (modified Medical Research Council score 3), exercise capacity increased (6-minute walk distance: 220 m), and ventilator use was discontinued. No complications or recurrence were observed during follow-up.
Percutaneous aspiration and drug injection refine target bronchus identification when imaging yields ambiguous results, enhancing precision for subsequent bronchoscopic interventions. This strategy minimizes reliance on endobronchial valves, reducing costs and procedural complexity. Larger studies are needed to validate long-term efficacy, but this approach offers a promising minimally invasive alternative for high-risk patients.
慢性阻塞性肺疾病中的巨大肺大疱（GEB）会导致严重的呼吸功能障碍。虽然手术切除是标准治疗方法，但对于不适合手术的患者，支气管镜下减容术至关重要。使用传统成像技术准确识别目标支气管仍然具有挑战性。
一名67岁男性，患有慢性阻塞性肺疾病和右肺GEB，出现严重呼吸困难（改良医学研究委员会评分为4分）、高碳酸血症（二氧化碳分压：45 mmHg）以及运动耐力明显受限（6分钟步行距离：62米）。他需要在家中进行无创通气，由于肺功能严重受损（第1秒用力呼气量：0.36升，预测值的12.2%），被认为不适合手术。
术前高分辨率计算机断层扫描（CT）和三维重建将目标支气管定位到右中叶。然而，经引流管进行经皮抽吸和药物注射显示存在偏差，促使重新确定目标支气管位于右上叶后段。
进行了CT引导下经皮GEB减容术，包括抽出气体和向肺大疱内注射乳糖酸红霉素。随后通过支气管镜自体血和凝血酶注射对右上叶后段进行选择性支气管封堵。术后维持持续负压引流。
6个月后的随访CT证实GEB完全闭合。呼吸困难明显改善（改良医学研究委员会评分为3分），运动能力增强（6分钟步行距离：220米），并停止使用呼吸机。随访期间未观察到并发症或复发。
当成像结果不明确时，经皮抽吸和药物注射可完善目标支气管的识别，提高后续支气管镜干预的精度。该策略最大限度地减少了对支气管内瓣膜的依赖，降低了成本和操作复杂性。需要更大规模的研究来验证长期疗效，但这种方法为高危患者提供了一种有前景的微创替代方案。
