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THE JOURNAL OF CARDIOVASCULAR SURGERY

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The Journal of Cardiovascular Surgery 1998 April;39(2):237-43

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Lung volume reduction surgery for emphysema. A review

Sabanathan A., Sabanathan S.†, Shah R., Richardson J.

From the Department of Cardio-Thoracic Surgery Bradford Royal Infirmary, Bradford, UK


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Lung ­volume reduc­tion sur­gery is ­emerging as a prom­ising treat­ment ­option for ­selected ­patients ­with ­severe, debil­i­tating end-­stage emphy­sema refrac­tory to med­ical man­age­ment. ­Lung ­volume reduc­tion sur­gery ­involves the ­removal of ­space occu­pying ­severely dis­eased, ­slowly ven­ti­lating and hyper­ex­panded ­lung, ­thus ­allowing the ­better con­served ­adjoining ­lung paren­chyma to ­expand ­into the ­vacated ­space and func­tion effec­tively. The oper­a­tion can be accom­plished by uni­lat­eral or bilat­eral tho­ra­cos­copy, thor­a­cotomy or ­median ster­notomy. The ­most emphy­sem­a­tous ­areas are ­excised ­using sta­pling or ­laser tech­niques or ­both. ­This ­review sum­mar­ises the ­results of ­lung ­volume reduc­tion sur­gery per­formed by var­ious oper­a­tive tech­niques. ­Results indi­cate ­that in the ­majority of ­patients improve­ment ­occurs in sub­jec­tive dysp­noea and objec­tive pul­mo­nary func­tion ­while ­oxygen and ­steroid depen­dence are ­reduced or elim­i­nated at the ­cost of accept­able mor­tality and mor­bidity. ­Even ­though bilat­eral pro­ce­dures pro­duced ­much ­greater improve­ment, it is empha­sized ­that it is the ­lung resec­tion and not the oper­a­tive ­approach ­that is crit­ical to the suc­cess of the oper­a­tion. Regard­less of the tech­nique ­used, the sur­gical treat­ment of emphy­sema is pal­li­a­tive in ­nature.

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