Brenner M, Kafie F E, Huh J, Yoong B, Budd M, Chen J C, Waite T A, Mukai D, Wang N S, McKenna R, Fischel R, Gelb A, Wilson A F, Berns M W
Pulmonary and Critical Care Medicine, University of California Irvine Medical Center, Orange 92668, USA.
J Invest Surg. 1998 Jul-Aug;11(4):281-8. doi: 10.3109/08941939809032203.
Clinical use of staple lung volume reduction surgery (LVRS) has proliferated for treatment of emphysema despite limited data regarding efficacy or optimal techniques. Recent studies in animal models of obstructive lung disease describe the decrease in lung compliance and increase in airway support as mechanisms of an improvement in pulmonary functions analogous to human data. We describe contrasting results in an animal model of bullous lung disease with a mixed but predominantly restrictive pattern of lung disease. Mixed restrictive and bullous lung disease was induced in 17 New Zealand white rabbits with i.v. Sephadex beads and endotracheally instilled carrageenan. Unilateral stapled lung volume reduction surgery was performed at 5 weeks postinduction of emphysema on the right lower lobe by lateral thoracotomy using a pediatric stapler. Static trans-pleural pressures were measured at 60, 40, and 20 cm3 inflation at preinduction (baseline), pre- and postoperatively, and 1 week postoperatively in anesthetized animals. Lungs were then harvested en bloc and examined histopathologically. The effects of volume reduction surgery on static lung compliance, lung conductance, and forced expiratory flows (FEF) were assessed. Five weeks after induction of lung disease, the animals had no significant change in static compliance and forced expiratory volume in 0.5 s (FEV0.5) or lung conductance compared to baseline. Immediately following LVRS, the animals showed a significant decrease in static compliance, FEV0.5, and conductance. One week postoperatively, compliance increased to approximately baseline levels along with a slight increase in FEFs and conductance toward preoperative levels. Histology examination revealed restrictive and bullous lung disease. Thus, we have demonstrated the feasibility of using an animal model for evaluation of volume reduction therapy for restrictive-obstructive lung disease. Physiologically, this model showed decrease conductance and decreased forced expiratory flows following lung volume reduction despite increased recoil. This is in contrast to increased conductance and flows seen in humans with severe emphysema following surgery and suggests that current criteria excluding patients with a significant restrictive component to their lung disease from LVRS surgery may be justified.
尽管关于疗效或最佳技术的数据有限，但吻合器肺减容手术（LVRS）在临床上已广泛用于治疗肺气肿。最近在阻塞性肺病动物模型中的研究表明，肺顺应性降低和气道支撑增加是肺功能改善的机制，这与人类数据相似。我们描述了在以混合性但主要为限制性肺病模式的大疱性肺病动物模型中得出的对比结果。通过静脉注射葡聚糖凝胶珠和气管内注入角叉菜胶，在17只新西兰白兔中诱发混合性限制性和大疱性肺病。在肺气肿诱导后5周，通过小儿吻合器经侧胸壁切开术对右下叶进行单侧吻合器肺减容手术。在麻醉动物的诱导前（基线）、术前和术后以及术后1周，分别在充气量为60、40和20 cm3时测量静态跨胸膜压力。然后将肺整体切除并进行组织病理学检查。评估了减容手术对静态肺顺应性、肺传导率和用力呼气流量（FEF）的影响。在肺病诱导5周后，与基线相比，动物的静态顺应性、0.5秒用力呼气量（FEV0.5）或肺传导率无显著变化。LVRS术后即刻，动物的静态顺应性、FEV0.5和传导率显著降低。术后1周，顺应性增加至接近基线水平，同时FEF和传导率略有增加，趋向术前水平。组织学检查显示为限制性和大疱性肺病。因此，我们证明了使用动物模型评估限制性 - 阻塞性肺病减容治疗的可行性。在生理上，该模型显示肺减容后传导率降低和用力呼气流量减少，尽管回缩增加。这与严重肺气肿患者术后观察到的传导率和流量增加形成对比，表明目前将有显著限制性成分的肺病患者排除在LVRS手术之外的标准可能是合理的。
