PDF(Pubmed)
Abstract：
Endoscopic lung volume reduction (ELVR) is an established treatment option for patients with severe emphysema. Not all patients are candidates for this type of intervention, and in the context of significant airway secretions, they may be excluded from treatment. Bronchial Rheoplasty (BR) was developed to treat mucus hypersecretion by delivering nonthermal pulsed electric fields to the airway epithelium and submucosa. The literature to date demonstrates that patients treated with BR in clinical studies have a reduction in airway goblet cell hyperplasia as well as substantive clinical improvement in the setting of chronic bronchitis (CB). In this case series, we present four patients treated at three different institutions who had previously undergone ELVR with beneficial outcome. However, over time, these patients subsequently developed worsening clinical issues, including complaints of increased and thickened mucus, along with exacerbations in the setting of a loss of some ELVR-associated benefits. These patients then underwent exploratory treatment with BR with the intent of reducing their secretion burden and potentially restoring the efficacy associated with the initial placement of the airway valves. All BR procedures were well tolerated, and three of the four patients showed substantial improvement in their symptom burden. Airway examinations during the second of the two BR procedures also revealed what appeared to be less airway mucosal inflammation and a decrease in the quantity of airway secretions. Therefore, treatment with BR may have the potential to improve and restore the initial benefits associated with ELVR, thus enhancing long-term outcomes. Further clinical studies with sufficient follow-up are warranted to assess this in a larger cohort of patients, and to determine whether treatment with BR prior to ELVR may make more patients eligible for this treatment through reduction in their secretions and/or symptoms.
摘要：
内镜肺减容术（ELVR）是严重肺气肿患者的既定治疗选择。并非所有患者都是这种干预的候选人，在大量气道分泌物的情况下，他们可能会被排除在治疗之外。支气管流变成形术（BR）通过向气道上皮和粘膜下层传递非热脉冲电场来治疗粘液分泌过多。迄今为止的文献表明,在临床研究中用BR治疗的患者在慢性支气管炎(CB)的情况下具有气道杯状细胞增生的减少以及实质性的临床改善。在这个系列中,我们介绍了4例在3个不同机构接受治疗的患者,这些患者以前接受过ELVR,结果有益.然而,随着时间的推移,这些患者随后出现了恶化的临床问题，包括粘液增加和增厚的抱怨，随着一些ELVR相关益处丧失的情况恶化。然后，这些患者接受BR的探索性治疗，目的是减少他们的分泌负担，并可能恢复与气道瓣膜初始放置相关的功效。所有BR程序都耐受良好，4名患者中有3名患者的症状负担显着改善。在两次BR手术中的第二次中进行的气道检查还显示，气道粘膜炎症似乎较少，气道分泌物数量减少。因此,用BR治疗可能有可能改善和恢复与ELVR相关的初始益处，从而提高长期成果。有足够随访的进一步临床研究需要在更大的患者队列中评估这一点。并确定在ELVR之前用BR治疗是否可以通过减少分泌物和/或症状使更多患者有资格接受这种治疗。
