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A Journal on Otorhinolaryngology, Head and Neck Surgery,
Plastic Reconstructive Surgery, Otoneurosurgery

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Otorinolaringologia 2001 March;51(1):27-46

language: Italian

Role of surgery in lung emphysema

Rena O., Oliaro A.

Università degli Studi - Torino Cattedra di Chirurgia Toracica


Lung em­phy­se­ma is as­so­ciat­ed ­with ­high mor­bid­ity and mo­ral­ity ­rates. During the ­last ­decades, dif­fer­ent sur­gi­cal pro­ce­dures ­have ­been per­formed in the man­age­ment of the bul­lous (bul­lec­to­my) and dif­fuse em­phy­se­ma (lung trans­plan­ta­tion or ­lung vol­ume re­duc­tion sur­gery). Bullectomy is ap­plied in ­those pa­tients af­fect­ed by ­large or ­giants bul­lae caus­ing func­tion­al im­pair­ment or sec­on­dary pleu­ral or pul­mo­nary pa­thol­o­gies ­such as em­pye­ma, he­mop­ty­sis or pul­mo­nary in­fec­tions. During the ‘80s ­lung trans­plan­ta­tion be­came a re­al­ity in the treat­ment of end-­stage pul­mo­nary em­phy­se­ma in se­lect­ed pa­tients. After ­lung trans­plan­ta­tion, sin­gle or bi­lat­er­al, sig­nif­i­cant im­prove­ment of the func­tion­al stat­us and qual­ity of ­life are re­ferred, ­even if the re­sid­u­al ­life is lim­it­ed by chron­ic re­jec­tion and in­fec­tions. Lung vol­ume re­duc­tion sur­gery, per­formed the ­first ­time in 1957 by Brantigan and Mueller, has ­been re-dis­cov­ered by Cooper et al. in the ‘90s. The ­most af­fect­ed ar­e­as of the ­lung, pre­vi­ous­ly de­tect­ed by ­high res­o­lu­tion com­put­ed to­mog­ra­phy and per­fu­sion scin­tig­ra­phy, are ex­cised by mul­ti­ple ­wedge re­sec­tions. This pro­ce­dure al­lows re­duc­tion of the ­lung vol­umes, im­prove­ments in the tho­rac­ic me­chan­ic ­such as the pul­mo­nary func­tion and ex­er­cise tol­er­ance ­with sig­nif­i­cant re­duc­tion of dysp­noea and dis­ease-re­lat­ed symp­toms. Unfortunately, ­these re­sults are lim­it­ed and the pro­gres­sion of the under­ly­ing dis­ease re­stores the pre­op­er­a­tive con­di­tions in 12-24 ­months ­even in se­lect­ed pa­tients.

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