支气管封堵试验在早产儿重度支气管肺发育不良伴严重肺叶气肿中的应用1例

The use of bronchial occlusion test in a preterm infant with severe bronchopulmonary dysplasia complicated by severe lobar emphysema

摘要:

重度支气管肺发育不良（bronchopulmonary dysplasia, BPD）的患儿可合并严重肺叶气肿造成通气障碍，临床管理非常困难，少数患儿需要切除过度气肿的肺叶才能改善通气。但是这些患儿在术前很难评估肺叶切除后剩余的肺叶是否能够提供足够的通气，且术前准备及术中/术后管理也都具有很大的挑战性。该文报道1例重度BPD伴重度右上叶气肿的患儿通过多学科紧密协作，在纤维支气管镜引导下行支气管封堵试验，评估右上肺叶切除手术的安全性及有效性后，安全行右上肺叶切除术的治疗过程，以帮助同行了解支气管封堵术在重度BPD伴严重肺叶气肿患儿评估肺叶切除安全性及有效性中的应用。重度BPD患儿已经存在严重肺发育不良及肺损伤，肺叶切除应被视为非常规治疗手段，不应随意进行。支气管封堵试验对于重度BPD合并肺气肿患儿可以是术前评估肺叶切除风险和获益的有效手段，但技术难度大，需在经验丰富的多学科团队紧密协作下完成。

Abstract:

In infants with severe bronchopulmonary dysplasia (sBPD), severe pulmonary lobar emphysema may occur as a complication, contributing to significant impairment in ventilation. Clinical management of these infants is extremely challenging and some may require lobectomy to improve ventilation. However, prior to the lobectomy, it is very difficult to assess whether the remaining lung parenchyma would be able to sustain adequate ventilation postoperatively. In addition, preoperative planning and perioperative management are also quite challenging in these patients. This paper reports the utility of selective bronchial occlusion in assessing the safety and efficacy of lobectomy in a case of sBPD complicated by severe right upper lobar emphysema. Since infants with sBPD already have poor lung development and significant lung injury, lobectomy should be viewed as a non-traditional therapy and be carried out with extreme caution. Selective bronchial occlusion test can be an effective tool in assessing the risks and benefits of lobectomy in cases with sBPD and lobar emphysema. However, given the technical difficulty, successful application of this technique requires close collaboration of an experienced interdisciplinary team.