LUNG-VOLUME REDUCTION IN PATIENTS WITH SEVERE DIFFUSE EMPHYSEMA - A RETROSPECTIVE STUDY

Background: For most authors, surgery of emphysema is restricted to re section of large bullae, whereas resection of small bullae or lung vol ume reduction is generally considered to have poor results. Study obje ctive: To report our experience of lung volume reduction in patients w ith severe emphysema without large bullae. Patients: Thirteen patients were operated on from 1982 to 1992. Before surgery, they all had seve re diffuse emphysema with a dyspnea grade 4 or 5 and mean FEV(1) value s 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 res ults: Postoperative assessment included dyspnea grading, FEV(1) measur ements, and blood gas analysis followed at 6- to 12-month intervals. T here was no perioperative mortality and the morbidity was limited. At 6, 12, 18, 24, and 36 months postoperatively, a symptomatic improvemen t was observed in 92%, 85%, 54%, 31%, and 31% of the patients, respect ively, with FEV(1) increasing by at least 20% in 92%, 46%, 46%, 31%, a nd 24% of the patients, respectively. Conclusion: Our data show that l ung volume reduction may result in symptomatic and spirometric improve ment in patients with severe emphysema without large bullae.