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J Thorac Cardiovasc Surg 1996;111:317-322
© 1996 Mosby, Inc.
GENERAL THORACIC SURGERY |
Orange, Lakewood, and Irvine, Calif.
Sponsored by Quentin R. Stiles, MD
Los Angeles, Calif.
*Supported in part by Department of Education grant DE-f603-91 ER61227 and National Institutes of Health grant R01192.
Address for reprints: Robert J. McKenna, Jr., MD, 1245 Wilshire Blvd., Suite 606, Los Angeles, CA 90017.
Abstract
Two procedures (laser bullectomy and lung reduction surgery with staples) are currently available for the surgical treatment of patients with diffuse emphysema. We compared the efficacy of these two surgical approaches in 72 patients, aged 67 ± 7 years (mean ± standard deviation), who had diffuse emphysema scored as severe on computed tomography and severe fixed expiratory airflow obstruction. The patients were prospectively randomized to undergo either neodymium:yttrium aluminum garnet contact laser surgery (n = 33) or stapled lung reduction surgery (n = 39) by unilateral thoracoscopy. The operative mortalities were 0% and 2.5%, respectively. No significant differences were noted between the groups (p < 0.05) with respect to operating time, hospital days, or air leakage for more than 7 days. However, a delayed pneumothorax developed in six patients (18%) who had laser treatment (p = 0.005). The operations eliminated dependency on supplemental oxygen in 52% of the laser group and 87.5% of the stapled lung reduction group (p = 0.02). The mean postoperative improvement in the forced expiratory volume in 1 second at 6 months was significantly greater for the patients undergoing the staple technique (32.9% vs 13.4%, p = 0.01) than for the laser treatment group. (J THORACCARDIOVASCSURG1996;111:317-22)
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G. CRINER, F. C. CORDOVA, V. LEYENSON, B. ROY, J. TRAVALINE, S. SUDARSHAN, G. O'BRIEN, A. M. KUZMA, and S. FURUKAWA Effect of Lung Volume Reduction Surgery on Diaphragm Strength Am. J. Respir. Crit. Care Med., May 1, 1997; 157(5): 1578 - 1585. [Abstract] [Full Text]
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M. D. BECKER, Y. M. BERKMEN, J. H. M. AUSTIN, I. K. MUN, B. M. ROMNEY, A. ROZENSHTEIN, P. A. JELLEN, C. K. YIP, B. THOMASHOW, and M. E. GINSBURG Lung Volumes before and after Lung Volume Reduction Surgery . Quantitative CT Analysis Am. J. Respir. Crit. Care Med., May 1, 1997; 157(5): 1593 - 1599. [Abstract] [Full Text]
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S. R. Hazelrigg, M. J. Magee, and T. M Boley Thoracoscopy for Management of Lung Disease (Including Emphysema) Surgical Innovation, December 1, 1996; 3(4): 224 - 232. [Abstract] [PDF]
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K. S. Naunheim and M. K. Ferguson The Current Status of Lung Volume Reduction Operations for Emphysema Ann. Thorac. Surg., August 1, 1996; 62(2): 601 - 612. [Abstract] [Full Text]
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