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Lung volume reduction in patients with severe diffuse emphysema. A retrospective study
1Service de Pneumologie et Réanimation Respiratoire, Hôpital Beaujon, Clichy, France.
Background:
For most authors, surgery of emphysema is restricted to resection of large bullae, whereas resection of small bullae or lung volume reduction is generally considered to have poor results.
Study Objective:
To report our experience of lung volume reduction in patients with severe emphysema without large bullae.
Patients:
Thirteen patients were operated on from 1982 to 1992. Before surgery, they all had severe diffuse emphysema with a dyspnea grade 4 or 5 and mean FEV1 values of 18 +/- 5% of predicted. Seven patients had a PaCO2 greater than 42 mm Hg. On radiologic evaluation, they had either small bullae or, most often, areas of destroyed lung.
Intervention:
The surgical procedure was unilateral in 11 patients and bilateral in 2.
Measurements And Results:
Postoperative assessment included dyspnea grading, FEV1 measurements, and blood gas analysis followed at 6- to 12-month intervals. There was no perioperative mortality and the morbidity was limited. At 6, 12, 18, 24, and 36 months postoperatively, a symptomatic improvement was observed in 92%, 85%, 54%, 31%, and 31% of the patients, respectively, with FEV1 increasing by at least 20% in 92%, 46%, 46%, 31%, and 24% of the patients, respectively.
Conclusion:
Our data show that lung volume reduction may result in symptomatic and spirometric improvement in patients with severe emphysema without large bullae.