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Bronchoscopic Lung Volume Reduction: A 2018 Review and Update

机译:支气管镜肺缩小:2018年回顾和更新

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摘要

Bronchoscopic lung volume reduction (BLVR) procedure has expanded the treatment spectrum of patients with end-stage emphysema. These treatments include valve, coil, thermal vapor ablation, bio-lung volume reduction, targeted lung denervation, and airway bypass stent. This short review provides an up-to-date information on BLVR treatments, their clinical benefits, and an overview of complications. BLVR treatments generally affect dyspnea by reducing hyperinflation and residual volume (RV). Benefits of treatment are associated with improvement in lung function parameters (forced expiration volume in the first second, total lung capacity, RV, and 6-minute walking test) and quality of life. Serious potential pulmonary complications, such as pneumothorax, pneumonia, respiratory failure, and chronic obstructive pulmonary disease exacerbation, may also occur after BLVR treatment. In addition to these, low-cost BLVR methods, such as autologous blood and fibrin glue, are in the developmental stage. Bronchoscopic lung volume reduction treatments are a promising method with positive results for patients with severe emphysema. The widespread use of these techniques, inadequate selection of patients, and non-critical and, therefore, unsuccessful use of BLVR in non-specialist centers lead to a false negative impression of the effectiveness of these techniques. In addition to these considerations, it is obvious that these treatments, which are quite expensive, are burdening social health systems. The reduction of costs or the development of lower-cost treatment methods is important for the future and for the availability of treatments.
机译:支气管镜肺减容术(BLVR)扩大了晚期肺气肿患者的治疗范围。这些治疗方法包括瓣膜,线圈,热蒸汽消融,减少生物肺体积,靶向肺去神经支配和气道旁路支架。这篇简短的评论提供了有关BLVR治疗,其临床益处以及并发症概述的最新信息。 BLVR治疗通常会通过减少过度充气和残留量(RV)来影响呼吸困难。治疗的益处与改善肺功能参数(第一秒钟的强制呼气量,总肺活量,RV和6分钟步行测试)和生活质量有关。 BLVR治疗后也可能发生严重的潜在肺部并发症,例如气胸,肺炎,呼吸衰竭和慢性阻塞性肺疾病恶化。除了这些以外,低成本的BLVR方法(例如自体血液和纤维蛋白胶)正处于开发阶段。支气管镜下肺减容治疗是一种有前途的方法,对于患有严重肺气肿的患者具有积极的效果。这些技术的广泛使用,患者的选择不足以及非关键性的,因此在非专业中心使用BLVR均未成功,导致对这些技术的有效性产生了负面的负面印象。除了这些考虑因素外,很显然,这些昂贵的治疗方法正在给社会卫生系统增加负担。降低成本或开发成本更低的治疗方法对于未来和治疗的可用性至关重要。

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