An Alternative Technique in the Management of Bullous Emphysema (Results)

9 Jan
2014

An Alternative Technique in the Management of Bullous Emphysema (Results)Because of skepticism about the safety of surgical intervention, in all 79 patients, only one lung was treated. No bilateral operations were performed simultaneously or sequentially. In most patients, the bullae occupied most of the upper lobes and varying amounts of the middle and lower lobes. Ablation of the bullae consisted of at least two to three precise ligations of each bulla cyst with preservation of normal lung parenchymal tissue as much as possible. In some instances, small bullae with wide bases were simply ligated together within a single loop. There was no intraoperative morbidity or mortality attributable to the procedure. The operating room time ranged from 40 to 110 min (mean, 70 min). The average duration of ventilator support was 19 h (range, 5 h to 7 days). Of the 79 patients, four received ventilator support for more than 72 h. Among them, one patient required a tracheostomy. Weaning off the ventilator occurred on day 7. generic zyrtec

Three patients (3.8%) suffered from progressive and extensive subcutaneous emphysema that required placement of a second chest tube after the operation. The average stay in the ICU was 1.0±0.5 days. Nonfatal complications occurred in 17 patients (21.5%). These included three minor wound infections and seven patients (8.9%) with prolonged air leaks (>10 days). Two patients had suspected empyema with purulent discharge from the chest tube; all of these patients were treated conservatively. The mean duration of chest drainage was 6 days (range, 4 to 16 days). The length of hospital stay varied from 5 to 26 days (mean, 9.5 days). Four patients who had oxygen dependency were transferred back to the medical ward for intensive rehabilitation. All have subsequently returned to their homes.

Among 19 patients who had preoperative bron-chospirometries (Table 2), the mean preoperative FEA’i was 0.85 L, representing 27% of the predicted value. At 3-month follow-up, 16 had pulmonary function reevaluations after the operation that showed an increase in FEVi to 1.02 L (p<0.0001) or 38% of predicted (Table 3). Similar improvements in FVC were noted after endoloop ligation procedure. Residual volume also showed significant (p<0.0001) declines after operation. The diffusion of carbon monoxide (Deo) was also significantly improved after operation, from 37% before operation to 43% after operation. Sixty-five patients (82%) exhibited subjective improvement in their symptom status at a 3-month follow-up. Among them, 17 (26%) patients were in MMRC grade 1 (initially in MMRC grade 2), and 48 (74%) patients exhibited dyspnea status from grade 3 to grade 2. Postoperative chest radiographs in this group of patients at 1 month showed significant “volume reduction” compared with the preoperative chest radiographs. The dome-shaped hemi-diaphragm was particularly prominent in comparison to the flat hemidiaphragm preoperatively. During the follow-up period of 5 to 37 months, five patients were known to be living but did not return, seven were unavailable for follow-up, and two patients died. The causes of late deaths were respiratory failure and pneumonitis. There was no recurrence after a mean follow-up of 21 months.

Table 2—Preoperative Pulmonary Function Test

Parameter*Value% Predicted Value
FEVx, L0.85+0.3127
FVC, L2.30±0.2658
MW, L/min26.0± 10.023
RV, L 5.10± 1.20 237
Deo37.0±3.5

Table 3—Postoperative Pulmonary Function Test: Three-Month Follow-up

Parameter*Value% Predicted Valuep Value
FEV1? L1.02±0.238<0.0001
FVC, L2.70±0.1565<0.0001
MW, L/min35.0±18.031<0.0001
RV, L4.10±0.3197<0.0001
Deo43.0±1.3NSf
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