title: [Pulmonary emphysema: surgical indications].
abstract: 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.
authors.affiliation: Service de Pneumologie et Réanimation respiratoire, Hôpital Beaujon, Clichy.
authors.forename: H
authors.initials: H
authors.lastname: Mal
authors.forename: C
authors.initials: C
authors.lastname: Roué
authors.forename: C
authors.initials: C
authors.lastname: Sleiman
authors.forename: M
authors.initials: M
authors.lastname: Fournier
authors.forename: P
authors.initials: P
authors.lastname: Baldeyrou
authors.forename: J P
authors.initials: JP
authors.lastname: Duchatelle
authors.forename: B
authors.initials: B
authors.lastname: Debesse
authors.forename: O
authors.initials: O
authors.lastname: Raffy
authors.forename: G
authors.initials: G
authors.lastname: Mangiapan
authors.forename: G
authors.initials: G
authors.lastname: Jebrak
authors.forename: F J
authors.initials: FJ
authors.lastname: Roux
authors.forename: B
authors.initials: B
authors.lastname: Andreassian
authors.forename: R
authors.initials: R
authors.lastname: Pariente
mesh_terms: D006801:Humans; D016040:Lung Transplantation; D011013:Pneumonectomy; D011656:Pulmonary Emphysema / Q000601:surgery*
vernacular_title: Emphysème pulmonaire: indications chirurgicales.