Abstract
Background: Despite of a modern level of anestesiology, reanimation and surgical technics lethality after LVRS remains on range 2,5-4% and level of complications in some clinics reaches 20%.
Aim: To fulfil a technique of bronchoscopic valve lung volume reduction (BLVR) in management of COPD patients, to develop indications and contra-indications.
Materials and methods: 9 patients are undergone BLVR. Mean age was 56 y. All have severe dyspnoe from 3 up to 4 points on scale MRC, FEV1 - 25±3%, TLC - 134±23%, RV - 287±34%, a distance in 6-m test - 245±45 m. Criteria of inclusion in BLVR program were similar to those at a LVRS. Procedures were performed under local anesthesia with intravenous potentiation. Intervention carried out on one lung in 8 cases. 1 patient undergone consecurive bilateral BLVR. The unilateral valve of manufacture of “Medlung” (Russia) was established in a bronchial tube of the most amazed lobe or segmentary bronchial tubes of adjacent lobes for prevention of air bypass. The quantity of valves on one procedure varied from 1 up to 2. Average duration of procedure was 35±12 minutes.
Results: All patients were discharged. Average hospital period was 4 days. 1 patients had severe allergy bronchitis in site of valve. 2 patients had severe COPD exerebration. 6 patients had marked reduction of dyspnoe, improving quality of life, increasing of physical tolerance, keeping up to 12 monthes after BLVR, including FEV1 - 30±3%, TLC - 102±3%, RV - 247±14%.
Conclusions: Preliminary results testify to efficiency, safety and expediency of BLVR in management of carefully selected severe COPD patients. We consider BLVR as a treatment option before LVRS and LT.
- © 2011 ERS
