目的 报告1例高龄慢性阻塞性肺病(COPD)患者成功经气管镜活瓣置入施行肺减容术治疗肺气肿,并就该技术的适应证和安全性进行探讨.方法 对1例80岁患者按COPD诊疗指南进行病情评估,予以高分辨CT、肺功能和6 min步行试验检查,确定其病情分级为D级,肺功能重度损害,有不均质肺气肿,符合肺减容手术适应证.予常规气管镜检查准备后,经鼻腔插入气管镜,使用Chartis导管插入侧枝通气各肺叶段检测后,选择左下叶内前基底段予以支气管单向活瓣置入.结果 患者良好耐受手术.单向活瓣置入位于左下叶内前基底段开口处,活瓣固定良好,随患者呼吸运动开闭正常.术后患者胸闷症状有所减轻,6 min步行距离增加.手术一周后胸片检查,活瓣无移位,活瓣远端肺透亮度较前降低.结论 高龄重度肺功能损坏慢性阻塞性肺病患者可使用单向活瓣置入术经气管镜肺减容术治疗,该技术需要更多病例应用并长期观察以进一步确定其有效性和安全性.%Objective We report a case of stage IV COPD aged palienls who accepted bronchoscopic lung volume reduction and discuss the efficacy and safely of the lechnique. Methods An 80-year aged palienl with COPD, grade D, was assessed and performed bronchoscopic lung volume reduclion. Full pulmonary funclion tests and baseline six-minute walking dislance test were examined before the operalion. Chartis syslem was used to determinernthe most emphysemalous lung segmenl during the operalion. Left inner and anlerior lung segmenl was chosen finally and an endobronchial one-way valve was placed using flexible bronchoscope. Results The palienls endured the operalion well. The valve was salisfacloryly fixed at the aimed posilion. Chest x-ray examination seven days after operalion indicated allenualed emphysema. Chesl lightness was relieved to some exlenl. Six-minute walking distance increased by 41 melers(23. 9% ) . Conclusion Bronchoscopic lung volume reduction is an encouraging alternative treatment for aged patient with severe COPD. More cases and long-term follow-up are needed to further confirm the efficacy and safety.
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