RT Book, Section
A1 Little, Alex G.
A2 Yuh, David D.
A2 Vricella, Luca A.
A2 Yang, Stephen C.
A2 Doty, John R.
SR Print(0)
ID 1104584906
T1 Surgical Management of Emphysema
T2 Johns Hopkins Textbook of Cardiothoracic Surgery
YR 2014
FD 2014
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-166350-2
LK accesssurgery.mhmedical.com/content.aspx?aid=1104584906
RD 2024/04/25
AB EpidemiologyIt  is  estimated  that  two  to  three  million  patients  suffer  from  emphysema.PathophysiologyExcept  for  rare  cases  caused  by  enzyme  deficiency,  smoking  is  the  cause  of  diffuse  emphysema.  The  smoke  destroys  lung  tissue  in  an  irreversible  fashion  leading  to  bullous  formation.  The  bullae  may  be  relatively  small  or  quite  large.Clinical  featuresPatients  are  hypoxic  and  dyspneic.  The  dyspnea  ranges  from  mild  to  the  need  for  home  oxygen  supplementation  with  subsequent  diminishment  in  the  quality  of  life.DiagnosticsClinically,  emphysema  is  a  subset  of  chronic  obstructive  pulmonary  disease  (COPD).  The  other  causes  of  COPD  including  chronic  bronchitis  and  hyperreactive  airways  can  coexist.  Emphysema  is  diagnosed  by  pulmonary  function  testing  that  shows  a  decrease  in  forced  expiratory  volume  in  1  second  (FEV1)  and  increase  in  total  lung  capacity  and  residual  volume.TreatmentMedical:  Cessation  of  smoking  eliminates  progression  of  the  disease  but  the  tissue  loss  is  irreversible.Surgical:  Appropriately  selected  patients  benefit  from  lung  volume  reduction  surgery  and/or  resection  of  giant  bullae.  Operative  mortality  is  minimal.  Operative  morbidity  is  significant  but  most  patients  recover  and  benefit  with  an  improved  quality  of  life.