肺気腫に対する肺容量減量手術

Lung Volume Reduction for Chronic Obstructive Pulmonary Disease

慢性閉塞性肺疾患（COPD）の患者数は，日本を含む世界各国で高齢化の進行に伴い増加している1）．現在，COPDは世界の死亡原因の第3位を占め，年間約300万人が死亡する致死率の高い疾患である2）．

Chronic obstructive pulmonary disease （COPD） is increasing with population aging and currently ranks as the third leading cause of death worldwide, accounting for approximately three million deaths annually. COPD is characterized by irreversible airflow obstruction, mainly caused by reduced lung elastic recoil due to peripheral airway lesions and emphysema. This condition results in lung hyperinflation, causing dyspnea, reduced exercise capacity, decreased physical activity, and an increased risk of heart failure. For patients with severe COPD unresponsive to medical therapies, surgical interventions, such as lung volume reduction surgery （LVRS）, bronchoscopic lung volume reduction （BLVR）, or lung transplantation, are considered. LVRS improves respiratory function by surgically removing hyperinflated lung tissue；however, due to its invasiveness and complication risks, fewer than 20 cases are performed annually in Japan. In contrast, BLVR, particularly bronchoscopic valve placement, is less invasive and has demonstrated effectiveness, especially in patients without collateral ventilation, and was approved for insurance coverage in Japan in 2023. Recent trials indicate BLVR significantly improves respiratory function and quality of life, though pneumothorax remains a notable complication. Appropriate patient selection based on clinical features, imaging findings, and pulmonary function evaluation is crucial, emphasizing individualized therapeutic strategies for COPD management.