Connolly J E, Wilson A
Department of Surgery, University of California, Irvine 92717.
J Thorac Cardiovasc Surg. 1989 Mar;97(3):351-61.
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.
绝大多数肺气肿病例是弥漫性的，累及肺的各个部分：显然，在这种情况下手术几乎没有作用。相比之下，有一种不常见的类型主要累及上叶以及舌叶和下叶的上部，相对正常运作的下叶则未受影响。有多种诊断测试可用于识别未受累下叶组织的受压情况，其中最可靠的方法是识别聚集在一起的肺血管。我们认为全肺断层扫描或肺血管造影能提供正常组织受压的最有说服力的证据。在经过适当选择的、正常肺组织有受压或移位的患者中，如果术后小心地通过辅助通气和延长胸腔闭式引流进行仔细的支持，即使是病情最重的患者也能耐受单纯切除肺大疱的开胸手术。19例患者无一死亡，结果令人满意，通常很显著，且令人惊讶地持久。很可能一些可手术治疗的肺大疱性肺气肿患者由于对肺大疱切除术可能带来的益处缺乏了解而未被研究或未得到手术治疗。
