Magyar sebeszet · 2004
[Role of surgical lung volume reduction in the treatment of patients with severe emphysema].
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Kecskés László, Füredi Arpád
Аннотация
OBJECTIVE: Based on literature data and own experience (unique in Hungary) we like to present the indications, contraindications, risks as well as medium and long term follow ups of the lung volume reduction surgery (LVRS) applicable in cases of therapeutic resistant end-stage emphysema (COPD).
MATERIAL: In Szombathely between 1997 and 2003, 69 LVRS--by multiple wedge resections of most functionless parts of the lungs--were made on 56 patients (44 males and 12 females with a mean age of 52.5 years) via median sternotomy for both sides (12 pts), axillary thoracotomy on one (30 pts) or both sides in two sessions (13 pts) and VATS (one side, 1 pt). Selection criteria based on radiographic, spirometric and cardiac function tests. Indications were: diffuse homogenous emphysema: 17 pts, heterogenous emphysema 39 pts. Combined surgery for severe COPD and pulmonary malignancy was applied too (7/56 pts - 12.5%).
RESULTS: Thirty-day operative mortality was 4.3% (3/69) similar to international results. We noticed high incidence of early complications: air leak (37.6%), serious arrhythmia (13%), respiratory insufficiency (8.7%), longer drainage time (5.7 days). Reoperations were 2/69 interventions (2.9%) because of air leak and bleeding. Late recurrent pneumothorax was observed in 1 case (1.3%). The mean follow up time was: 31.8 months. FEV1, RV, paO2, paCO2 and the quality of life improve as seen in follow-up, and patients regain apart of the former activity. There were no differences in the outcome in patients undergoing unilateral or bilateral LVRS. On the basis of literature and own data the long-term significant positive improvements last about 12-24 months. Thereafter one can observe a slow decrease of the cardiopulmonary functions, however, the quality of life remains adequate for longer.
SUMMARY: The LVRS has a certain risk, but perioperative mortality is acceptable. LVRS is a realistic alternative of lung transplantation in case of severe COPD first of all in patients presenting with heterogenous emphysema (particularly upper lobe) and low exercise capacity. The expense of LVRS is maximum 10% of lung transplantation. Patients having undergone an LVRS and patients unacceptable for LVRS can be suitable for lung transplantation.
MATERIAL: In Szombathely between 1997 and 2003, 69 LVRS--by multiple wedge resections of most functionless parts of the lungs--were made on 56 patients (44 males and 12 females with a mean age of 52.5 years) via median sternotomy for both sides (12 pts), axillary thoracotomy on one (30 pts) or both sides in two sessions (13 pts) and VATS (one side, 1 pt). Selection criteria based on radiographic, spirometric and cardiac function tests. Indications were: diffuse homogenous emphysema: 17 pts, heterogenous emphysema 39 pts. Combined surgery for severe COPD and pulmonary malignancy was applied too (7/56 pts - 12.5%).
RESULTS: Thirty-day operative mortality was 4.3% (3/69) similar to international results. We noticed high incidence of early complications: air leak (37.6%), serious arrhythmia (13%), respiratory insufficiency (8.7%), longer drainage time (5.7 days). Reoperations were 2/69 interventions (2.9%) because of air leak and bleeding. Late recurrent pneumothorax was observed in 1 case (1.3%). The mean follow up time was: 31.8 months. FEV1, RV, paO2, paCO2 and the quality of life improve as seen in follow-up, and patients regain apart of the former activity. There were no differences in the outcome in patients undergoing unilateral or bilateral LVRS. On the basis of literature and own data the long-term significant positive improvements last about 12-24 months. Thereafter one can observe a slow decrease of the cardiopulmonary functions, however, the quality of life remains adequate for longer.
SUMMARY: The LVRS has a certain risk, but perioperative mortality is acceptable. LVRS is a realistic alternative of lung transplantation in case of severe COPD first of all in patients presenting with heterogenous emphysema (particularly upper lobe) and low exercise capacity. The expense of LVRS is maximum 10% of lung transplantation. Patients having undergone an LVRS and patients unacceptable for LVRS can be suitable for lung transplantation.