Objective: To study the surgical treatment of emphysema.
Method: Five patients with severe diffused pulmonary emphysema underwent surgical bilateral lung volume reduction by video-assisted thoracoscopy. All patients were male and their age ranged from 60 to 71 years (mean 64.3 years). Before surgery, 5 patients required supplement oxygen with exertion and one oxygen supplement at rest. Preoperative and postoperative assessments included standard pulmonary function studies, chest CT scan and quantitative nuclear lung perfusion and ventilation scan. Wedge resection was performed were in 3 patients, simple plication in 1, and combined wedge resection and plication in 1. There were no early or late mortality and no requirement for immediate postoperative ventilatory assistance.
Result: Follow-up ranged from 10 to 12 months. After surgery the mean forced expiratory volume in 1 second (FEV(1)) was significantly increased from 0.46 L to 1.13 L (P < 0.001) and the mean forced vital capacity (FVC) was markedly improved from 1.74 L to 2.93 L (P < 0.001). Pulmonary compliance was significantly improved and resistance of airway decreased (P < 0.001). The mean distance during 6-min walk test increased from 10 m to 400 m in 4 patients.
Conclusion: Thoracoscopic bilateral lung volume reduction is an effective and safe technique for patients with severe emphysema. It can relieve dyspnea and improve in excise tolerance and quality of life.