title: [Late-stage emphysema treated with lung volume reduction: report of 22 cases].
abstract: OBJECTIVE
  To Summarize the clinical experience in the treatment of late-stage emphysema by lung volume reduction (LVR) in 5 years.
  
  
  METHODS
  We retrospectively studied the indications, contraindications, operation procedures and complications of LVR in 22 patients.
  
  
  RESULTS
  Before operation, the average FEV(1) was 24.5%, RV 196.8%, and TLC 130.5%; after operation they were 27.8%, 148.8% and 112.5%, respectively. 16 patients needed inhaling oxygen before operation, and 5 after operation. 16 patients finished 6-minute walking test with an average of 198 m, all patients walked much longer with an average of 256 m after operation. 3-degree lung function was observed in 14 patients, and 4-degree before operation in 8 patients; but 2-degree lung function in 5 patients, 3-degree in 13, and 4-degree in 4 after operation.
  
  
  CONCLUSIONS
  Heterogeneous type emphysema with clear target area, especially bullous emphysema is the best indication for LVR. Lung function and life quality could be much improved postoperatively. Homogeneous type could also be treated with LVR in highly selected cases. TLCO < 20% is not an absolute contraindication, others standards need further investigation. Video-assistant thoracoscopic surgery (VATS) with subaxillary small incision for LVR is safe, reliable and effective. Application of stapler buttressing with bovine pericardia could decrease air leakage postoperatively.
authors.affiliation: Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China.
authors.forename: Fengrui
authors.initials: F
authors.lastname: Zhao
authors.forename: Deruo
authors.initials: D
authors.lastname: Liu
authors.forename: Bin
authors.initials: B
authors.lastname: Shi
authors.forename: Yanchu
authors.initials: Y
authors.lastname: Tian
authors.forename: Zaiyong
authors.initials: Z
authors.lastname: Wang
authors.forename: Tong
authors.initials: T
authors.lastname: Bao
authors.forename: Futian
authors.initials: F
authors.lastname: Li
authors.forename: Yongqing
authors.initials: Y
authors.lastname: Guo
authors.forename: Haitao
authors.initials: H
authors.lastname: Zhang
authors.forename: Jingyu
authors.initials: J
authors.lastname: Chen
authors.forename: Bingsheng
authors.initials: B
authors.lastname: Ge
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011656:Pulmonary Emphysema / Q000601:surgery*; D012189:Retrospective Studies; D013906:Thoracoscopy