患有晚期肺气肿的病人经常出现严重的呼吸困难，仅仅用药物治疗无法获得充分的效果。在过去的4年中，我们发现了支气管镜下肺容积减少术（BLVR）使用的增加，并且通过引流阀支持该方法。手术的成功取决于对病人的选择，因为并不是所有严重肺气肿患者都适合进行该手术。（表1）本综述的目的是强调单一机构的选择过程，并讨论该过程对预后的影响。在2019年3月1日至2021年10月12日期间，共有2402名患者被转诊至Mayo Clinic - Rochester的专门慢阻肺诊所，其中161名患者随后被转诊进行多学科BLVR评估。在这些患者中，有53人（32.9%）被选择接受阀门，并最终有35人（21.7%）进行了手术。排除的主要原因包括不兼容的定量计算机断层扫描分析（n=37，34.3%）、存在肺结节或活动性恶性肿瘤（n=14，13.0%）或需要进行肺康复（n=9，8.3%）。其中58.6%接受阀门植入的病人出现了目标肺叶完全或部分（>70%）塌陷。那些出现塌陷的病人在肺功能检测指标上得到了统计学上显著的改善。12名患者发生了气胸（34.3%），其中10名患者需要胸腔闭式引流管的插入和延长住院时间（中位数11天，范围4-39天）。19名患者在第一年内需要进行次要手术。本研究强调了多学科BLVR选择过程的综合处理方法，使复杂手术能够个体化，并提高了拒绝不适合候选人的几率。

Patients with advanced emphysema frequently experience severe dyspnea that is inadequately treated with medical therapy alone. Over the past 4 years, we have seen increased usage of bronchoscopic lung volume reduction (BLVR) with endobronchial valves. Success of the procedure is dependent on patient selection because it is not necessarily appropriate for all patients with severe emphysema. (Table 1) The purpose of this review is to highlight the selection process at a single institution. We also discuss the influence of this process on outcomes. Between March 1, 2019, and October 12, 2021, 2402 patients were referred to a dedicated chronic obstructive pulmonary disease clinic at Mayo Clinic - Rochester, whereas 161 patients were subsequently referred for multidisciplinary BLVR review. Of those patients, 53 (32.9%) were selected to receive valves and 35 (21.7%) ultimately underwent the procedure. The main reasons for exclusion included an incompatible quantitative computed tomography analysis (n=37, 34.3%), presence of pulmonary nodule or active malignancy (n=14, 13.0%), or need for completion of pulmonary rehabilitation (n=9, 8.3%). Full or partial (>70%) target lobe collapse was observed in 58.6% of patients who received valves. Those with collapse experienced statistically significant improvements in spirometric measures. Twelve patients experienced a pneumothorax (34.3%), with 10 patients requiring thoracostomy tube placement and prolonged hospitalization (median, 11 days; range, 4-39 days). Nineteen patients required a secondary procedure within the first year. The study highlights how a multidisciplinary approach to the BLVR selection process enables individualization of a complex procedure and enhances the exclusion of inappropriate candidates.Published by Elsevier Inc.