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不做大型手术 也能治愈肺病?

Hospitals are testing new procedures to help patients with a devastating lung disease breathe easier without major surgery. 为了协助身患可怕肺病的病患在一动大手术的情况下也能更加精彩地排便,各家医院正在测试新的化疗手段。

本文摘要:Hospitals are testing new procedures to help patients with a devastating lung disease breathe easier without major surgery. 为了协助身患可怕肺病的病患在一动大手术的情况下也能更加精彩地排便,各家医院正在测试新的化疗手段。


Hospitals are testing new procedures to help patients with a devastating lung disease breathe easier without major surgery. 为了协助身患可怕肺病的病患在一动大手术的情况下也能更加精彩地排便,各家医院正在测试新的化疗手段。More than 15 million people have been diagnosed with chronic obstructive pulmonary disease, or COPD, according to the Centers for Disease Control and Prevention. Millions more may be unaware they have it. The disease is the third leading cause of death in the U.S., after heart disease and cancer. COPD costs nearly $30 billion in direct health care expenditures. 据美国疾病掌控和防治中心(Centers for Diesease Control and Prevention)称之为,多达1,500万人已发病患上慢性阻塞性肺疾病(或全称为COPD)。另外还有数百万人有可能不告诉自己身患此病。在美国,该疾病是位列心脏病和癌症之后的第三大死因。

在必要医保开支中,化疗慢性阻塞性肺疾病的涉及费用将近300亿美元。COPD is mainly caused by smoking, but the condition also has been linked with secondhand smoke, air pollution and workplace dust and chemicals. Genes may play a role in why some smokers develop it and some dont. 吸烟者是引起慢性阻塞性肺疾病的主要原因,但它也与二手烟、空气污染以及工作场所的粉尘和化学物质有关。基因有可能也不会起着一些起到,这也就是为什么有些烟民不会发展成COPD患者、而有些却未患病的原因。Some patients with severe cases of COPD may be referred for surgery, during which the diseased part of the lung is removed. But the risky and costly procedure isnt often used, partly because recovery is long and many patients experience complications after surgery. 一些病情严重的COPD患者有可能得送来去做手术,通过手术切除肺部的恶性肿瘤部位。

但这种有风险、乏财力的化疗手段并不常用,一部分原因是因为手术后的恢复期较长,而且很多病人还不会患上术后并发症。More than two dozen U.S. medical centers are currently testing a technique that places metal coils into the lung using special scopes inserted through the mouth or nose. Once in place, the coils compress the diseased tissue and allow the healthier parts of the lung to breathe more freely. Other hospitals are investigating a small-umbrella shaped valve that redirects air from less healthy to more healthy parts of the lung. 目前,美国有20多个医疗中心都在测试一种新技术:将类似的内窥镜通过口腔或鼻腔伸入人的体内,然后用它将金属线圈植入肺部。一切所在之处以后,金属线圈就不会断裂恶性肿瘤的组织,让肺上比较身体健康的部位更加权利地排便。其他医院也在研究一种小伞状阀门,它能把空气从肺上那些状况佳的部位新的引至更加身体健康的部位。

If successful, we will be able to help a significant number of patients have an improved quality of life, and potentially improve survival in a noninvasive manner, says Atul C. Mehta, an interventional pulmonologist at Cleveland Clinic, one the centers participating in the coils trial. 克利夫兰医院(Cleveland Clnic) 的介入治疗医师阿图尔·C·梅塔(Atul C. Mehta)说道:“如果顺利了,我们就能协助大量患者改善生活质量,而且有可能以一种无创伤性的方式提升生存率。”克利夫兰医院是参予了线?化疗试验的医学中心之一。In Europe, where the coils have been approved for use since 2008, studies have shown the treatment is safe for patients and results in significant improvements in pulmonary function, exercise capacity and quality of life. Current U.S. research is being funded by PneumRx Inc., the Mountainview, Calif., maker of the coils. While smokers can prevent COPD by quitting before it develops, once the lungs are damaged it isnt reversible. Most patients are managed with the use of inhaled medications called bronchodilators, oxygen and pulmonary rehabilitation. 在欧洲,这种线圈从2008年起就早已获批投入使用。欧洲的一些研究已表明,这种疗法对病人来说很安全性,而且能明显提高肺机能、运动能力与生活质量。

目前,美国的研究是由加州山景城(Mountainview, Calif.)的RneumRx Inc.公司资助的,该公司是所用线圈的制造商。虽然吸烟者可以在慢性阻塞性肺疾病构成前戒烟来展开防治,但一旦肺部损毁,那病情就无法反败为胜了。大多数患者都是靠用于取名为支气管扩张剂的吸入性药物、用氧和肺康复疗法来保持的。Mary Morgan, a nurse who lives in Parma, Ohio, was diagnosed seven years ago with emphysema, a form of COPD. Still, she continued to smoke for a few more years because the disease wasnt bothering me, she says. Two years ago, the 55-year-old came down with pneumonia and had to call 911 because she couldnt breathe. She quit smoking but needed to be on oxygen all the time. She gasped for breath often and wasnt able to speak more than a few words at a time. It gets to the point where you are living in such misery that you just dont want to go on, Ms. Morgan says. 玛丽·摩根(Mary Morgan)是住在俄亥俄州帕尔马(Parma, Ohio)的一名护士。



摩根说道:“早已病到这个地步了,如此伤痛折磨,都想再行活下去了。”After completing a pulmonary rehabilitation program, Ms. Morgan was accepted into the coils trial at the Cleveland Clinic last December. Dr. Mehta and another pulmonologist placed 12 of the small devices in her right lower lung. She was discharged from the hospital after just one night and says she felt improvements almost immediately. Tests a month later showed her breathing had improved by 30%. She is still on supplementary oxygen and is scheduled to have additional coils inserted in her left lung later this month. 摩根在已完成了一次肺康复化疗后,于去年12月份准许在克利夫兰医院拒绝接受线圈试验化疗。



COPD includes two main conditions, emphysema and chronic bronchitis, and most patients have elements of both. Emphysema, as it advances, destroys the air sacs, or alveoli, that exchange air between the lungs and surrounding tissue and bloodstream. Diseased portions of the lung overinflate, become inelastic and trap air. Meanwhile, the expanded sacs push against the lungs healthier areas. Patients may feel as if they are suffocating. Medications may cease to work. 慢性阻塞性肺疾病还包括两种主要的病症,肺气肿和慢性支气管炎,而大多数患者是两者兼备。随着肺气肿的病情减轻,它不会毁坏气?,或称作肺泡——它们负责管理互相交换肺部及周遭的组织与血流间的空气。

肺的恶性肿瘤部位将不会过度收缩、显得没弹性并逗留空气。于此同时,扩展的气囊也不会断裂肺部比较身体健康的部位。患者可能会深感窒息而死,而药物化疗则有可能过热。More severe cases of COPD affect an estimated three to four million people in the U.S. Dr. Mehta estimates as many as one million may be candidates for some form of lung volume reduction through surgery or the new less-invasive coil procedure. The surgery requires a large incision, or several small ones, in the chest to excise diseased tissue. The aim is to allow the patient to breathe easier with the remaining healthier portion of the lungs. 病情更加相当严重的慢性阻塞性肺疾病在美国估算影响到了三、四百万人。



其目的是为了能让病人用余下的、肺上比较身体健康的部位更容易地排便。In a large study a decade ago, called the National Emphysema Treatment Trial, the surgery didnt show an overall survival advantage over medical management. It did show an advantage in patients whose disease was worse in upper lobes of the lungs and whose exercise capacity was low. Still, the procedure is little used. Complication rates are high. Relatively few centers in the country offer the procedure. 10年前展开的一项取名为“全国肺气肿化疗试验”(National Emphysema Treatment Trial)的大型研究表明,与药物化疗比起,手术未显露出不会给病患在总体上带给更高的存活率。该研究倒是指出,在有些患者身上,手术疗法极具优势——这些患者的上肺叶恶性肿瘤更加相当严重,他们的运动能力也劣。


In the right patients, weve proven that lung reduction surgery works, but doctors arent referring patients for the procedure and patients arent interested in doing major surgery, says Frank Sciurba, director of the Pulmonary Function and Exercise Physiology Lab at the University of Pittsburgh Medical Center and principal investigator for its part of the coils-implant trial. One aim of the trial, he says, is to determine which patients have the right lung structure and physiology to benefit from the coils procedure. 匹兹堡大学医学中心(University of Pittsburgh Medical Center)肺功能与运动生理学实验室(Pulmonary Function and Exercise Physiology Lab)主任、该校部分线圈植入试验的主要研究者弗兰克·休尔巴(Frank Sciurba)说道:“我们早已证明,在合适动手术的病人身上,肺减容手术的确有效地,但医生们会将病患送来去拒绝接受这种疗法,而患者自身也对大手术没什么兴趣。”他还称之为,试验的目的之一就是确认什么样的患者享有适应环境线圈疗法的肺部结构与生理机能,从而能从该疗法中受益。

The coils trial isnt studying costs. In the long run the hope is this could be more cost-effective, says Dr. Sciurba, by reducing hospitalization costs, complications and readmissions. A PneumRx spokeswoman says the coils procedure in Europe costs $15,000. We arent yet far enough along in the U.S. market to have a valid comparison, she says. 线圈疗法的涉及试验未探究成本问题。休尔巴博士说道:“将来的期望是,(通过减少住院成本、增加并发症和再行入院的情况),该疗法能更加昂贵。”PneumRx公司的一名女发言人称之为,展开线圈疗法在欧洲必须花费1.5万美元。

她还说道:“我们仍未了解美国市场,所以还无法做出一个有效地的较为。”Experts have had mixed results with other nonsurgical techniques, such as chemical sealants and steam to destroy the diseased part of the lung. In another current clinical trial, researchers are guiding a small, umbrella-shaped valve into the airways that redirects air from less healthy to more healthy parts of the lung while letting trapped air escape. An earlier trial of the valves ended without meeting the requirements for Food Drug Administration approval, but Redmond, Wash., device maker Spiration Inc., is funding a new trial to determine if the procedure can help reduce over-inflation of the lung and improve overall lung function and quality of life. 而在其他非手术治疗技术方面,专家们已进账了优劣不一的结果,比如用化学密封剂和蒸汽去毁坏肺上的恶性肿瘤部位。

在目前另一起临床试验中,研究人员机车一个小伞型阀门转入气道,把空气从肺部佳的部位新的导至肺上更加身体健康的部位,同时让残余空气排出来。早些时候的一次阀门疗法试验因未符合美国食品药物管理局(Food Drug Administration)的证书拒绝而收场,但华盛顿州雷德蒙德市(Redmond, Wash.)器具制造商Spiration Inc. 公司现于是以出资展开一项新的试验,以证实这种疗法能否协助增加肺部过度收缩并提高肺的整体机能、提升生命的质量。D. Kyle Hogarth, director of bronchoscopy and assistant professor of medicine at the University of Chicago who is leading an arm of the valve study there, says a possible risk to the use of any device is infection from foreign bodies inserted into the lung. While coils arent designed to be removed, valves could be removed if necessary, he says. Because emphysema can affect individual patients lungs differently, in the future, patients may end up qualifying for both coils and valves, to treat different types of abnormalities and breathing problems, Dr. Hogarth says. 芝加哥大学(University of Chicago)的支气管镜检主任、医药学助理教授D·凯尔·贺加斯(D. Kyle Hogarth)于是以率领一队人在展开阀门研究。他说道,不管用于什么器具设备,都不存在这样一种潜在风险:植入肺部的外来物引起病毒感染。





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