Mal H, Roué C, Sleiman C, Fournier M, Baldeyrou P, Duchatelle J P, Debesse B, Raffy O, Mangiapan G, Jebrak G, Roux F J, Andreassian B, Pariente R
Service de Pneumologie et Réanimation respiratoire, Hôpital Beaujon, Clichy.
Presse Med. 1996 Apr 13;25(13):637-40.
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.
除肺移植外，目前肺气肿手术仅限于切除气肿区域。在其他实质健康的肺组织内切除单个肺大疱，在出现并发症的情况下可以考虑，但在无症状患者中很少进行。当患有弥漫性肺气肿的患者肺大疱较大（即体积大于半侧胸腔的三分之一）时，肺大疱切除术是理想的适应症。死亡率在0%至10%之间，主要是由于感染或急性呼吸衰竭。在大多数患者中，术后长达5年，呼吸困难的主观改善以及通过肺活量测定法测量的客观改善仍然显著。相反，对于肺大疱小且界限不清的患者，传统上认为手术切除是禁忌的。然而，最近的数据对这一观点提出了质疑，因为即使是那些严重阻塞的患者，在大多数患者中，术后1年肺容积减少后仍存在主观和客观改善。其机制可能与弹性回缩增加有关。即使只能在几年内实现暂时改善，肺气肿的持续病程表明，在进行肺移植之前，应始终考虑减容作为一种替代方案。
