Surgical treatment of bullous emphysema: experience with the Brompton technique.
The technique first described by Monaldi has been modified for the treatment of discrete emphysematous bullae. Fifty-eight patients (median age, 56 years) underwent this procedure between 1983 and 1992. The operative mortality was 6.9% (4 patients). Fifty-two patients (89.6%) noted symptomatic improvement, as measured using the modified Medical Research Council of Great Britain dyspnea scale, from a mean value of 3.7 preoperatively to 2.1 postoperatively. Two patients remained unchanged symptomatically. In all patients, amelioration of symptoms was accompanied by an objective improvement in lung function. A mean increase of 28% was noted in the forced expiratory volume in 1 second (p < 0.05), and a 12.3% improvement in the total lung capacity was observed (p < 0.002). The residual lung volume-total lung capacity ratio declined from a mean of 70% to 57% after operation. A forced expiratory volume in 1 second of less than 500 mL (p < 0.05) and carbon dioxide tension of greater than 6.5 kPa (p < 0.05) were significant predictors of poor prognosis. The median follow-up period has been 1.9 years (range, 0.5 to 9 years). Two patients have returned for further drainage of new bullae on the operated side, and this was carried out percutaneously in both. We conclude that this technique offers a simple, safe, and effective method for the treatment of discrete bullous disease in patients with emphysema.
Department of Thoracic Surgery, Royal Brompton National Heart and Lung Hospital, London, England.
S S
SS
Shah
P
P
Goldstraw
D000368:Aged; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D014797:Vital Capacity