[Pulmonary emphysema: surgical indications].
Surgery for pulmonary emphysema, with the exception of lung transplantation, is limited at present to resection of the emphysematous areas. The resection of a unique bulla within an otherwise healthy parenchyma can be indicated in case of complications but rarely in asymptomatic patients. When the bullae are large (i.e. volume greater than one-third of the hemithorax) in a patient suffering from diffuse emphysema, bullectomy is the ideal indication. Mortality varies from 0 to 10%, essentially due to infection or acute respiratory failure. In most patients, the subjective improvement in terms of dyspnea and the objective improvement as measured by spirometry remains significative up to 5 years after surgery. Inversely, surgical resection is classically considered to be contraindicated in patients with small poorly-limited bullae. Recent data would however question this idea since subjective and objective improvement after reduction of the lung volume is still present 1 year after surgery in most patients, even those with severe obstruction. The mechanism is probably related to increased elastic recoil. Even if only temporary improvement can be achieved for a few years, the persisting course of emphysema would suggest that volume reduction should always be entertained as an alternative before lung transplantation.
Mal
H
H
Service de Pneumologie et Réanimation respiratoire, Hôpital Beaujon, Clichy.
Roué
C
C
Sleiman
C
C
Fournier
M
M
Baldeyrou
P
P
Duchatelle
J P
JP
Debesse
B
B
Raffy
O
O
Mangiapan
G
G
Jebrak
G
G
Roux
F J
FJ
Andreassian
B
B
Pariente
R
R
D006801:Humans; D016040:Lung Transplantation; D011013:Pneumonectomy; D011656:Pulmonary Emphysema / Q000601:surgery*
Emphysème pulmonaire: indications chirurgicales.