Bronchoscopic volume reduction in severe emphysema

Hacim küçültücü cerrahi girişim, son dönem amfizematöz akciğer hastalıklarında medikal tedaviye alternatif olarak son on yıl içinde gelişme göstermiştir. Aynı amaca yönelik olarak endobronşiyal hacim küçültücü cerrahi de son zamanlarda cerrahiye uygun olmayan hastalarda kullanılmaya başlanmıştır. Bu yazıda iki taraflı alt loblarda belirgin amfizematöz akciğer hastalığı mevcut ve birinci saniyedeki zorlu ekspirasyon volüm (FEV 1) değeri 0.47 lt (%13) olan 55 yaşında bir erkek hasta sunuldu. Hastamızda alt lob amfizematöz segmentlerin oklüzyonu, rijit bronkosokopi eşliğinde segment ve altsegment düzeyinde dokuz adet Endobronchial Watanabe Spigotkonularak gerçekleştirildi. Olgumuzun altı aylık takip sonucunda FEV 1 değeri 0.74 lt (%21) olarak ölçüldü ve işlem öncesi değerlerin neredeyse iki katına ulaştı. Total akciğer kapasitesi ve rezidüel hacim sırası ile 9.2 lt (%102) ve 4.2 ltye (%150) geriledi. Bu tür minimal invaziv endobronşiyal yöntemler cerrahiye uygun olmayan ve nakil adayı olup bekleme listesinde bulunan hastalar için etkili bir yöntem olabilir.

İleri düzey amfizemde bronkoskopik hacim küçültme

For the past decade, volume reduction surgical intervention has been adopted for the management of end-stage emphysematous lung diseases, as an alternative to medical treatment. Within the same purpose, endobronchial volume reduction surgery has been used recently for the patients who are not eligible for surgery. In this article, we present a 55-year-old male patient with a significant bilateral lower lobe emphysematous lung disease accompanied by a forced expiratory volume in one second (FEV 1) value of 0.47 lt (13%). He underwent bronchoscopic occlusion of segmental and subsegmental bronchial occlusion using nine Endobronchial Watanabe Spigot s through rigid bronchoscope. After six months of follow-up, FEV 1 value was estimated as 0.74 lt (21%), which was nearly twofold increase compared to preoperative levels. Total lung capacity and residual volume was reduced to 9.2 lt (102%) and 4.2 lt (150%), respectively. This minimal invasive endobronchial methods may be effective in patients who are in the waiting list of transplantation or ineligible candidates for surgery.

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