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The Journal of Thoracic and Cardiovascular Surgery, Vol 97, 351-361, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JE Connolly and A Wilson
The great majority of cases of emphysema are generalized with diffuse
involvement of all portions of the lung: Clearly, surgery has little to
offer in such cases. In contrast, there is an uncommon variant involving
primarily the upper lobes and the superior portions of the lingula and
lower lobes, which spares the relatively normally functioning lower lobes.
A number of diagnostic tests are available to identify compression of
uninvolved lower lobe tissue, the most reliable of which identify pulmonary
vasculature that is crowded together. We suggest that whole lung tomograms
or pulmonary angiograms provide the most convincing evidence of compression
of normal tissue. In properly selected patients with compression or
displacement of normal lung, thoracotomy with simple excision of the bullae
is tolerated by even the most ill patients if care is taken to carefully
support the patient postoperatively with assisted ventilation and prolonged
chest tube suction. There were no deaths in 19 patients and the results
were rewarding, often spectacular, and surprisingly enduring. It is likely
that some patients with operable bullous emphysema are not being studied or
offered operation because of a lack of knowledge about the benefits
possible with bullectomy.
ARTICLES
The current status of surgery for bullous emphysema
Department of Surgery, University of California, Irvine 92717.
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