気管支鏡的肺容量減量術時代における肺容量減量手術の再評価―適応症例と治療戦略の最前線

Lung Volume Reduction Surgery in the Bronchoscopic Lung Volume Reduction Era：Reassessment of Indications and Strategies

気管支鏡的肺容量減量術（BLVR）は，低侵襲かつ可逆性がある治療法として近年急速に普及している．特に側副換気が存在しない不均一型肺気腫において有効性が示されているが，びまん性肺気腫や側副換気のある症例では効果が限定的である．このようなBLVRの制限を補完する治療法として，肺容量減量手術（LVRS）が再注目されている．本稿では，BLVRの歴史と発展，主要な臨床試験の結果，ガイドラインにおける位置づけを整理し，LVRSの現代的意義を多角的に論じる．

Bronchoscopic lung volume reduction （BLVR） and lung volume reduction surgery （LVRS） represent two complementary strategies in the management of advanced emphysema. BLVR has emerged as a minimally invasive and reversible approach, demonstrating significant clinical benefit in carefully selected patients without collateral ventilation, supported by advances in physiological assessment and imaging technologies. LVRS, by contrast, remains a well-validated surgical option offering sustained improvements in pulmonary mechanics, exercise tolerance, and quality of life, particularly in patients with heterogeneous upper-lobe predominant disease. Recent randomized trials have underscored the comparable efficacy of both modalities, highlighting the need for individualized, phenotype-driven treatment planning. A multidisciplinary, individualized approach is essential to optimize treatment selection.