Emphysema chronic progressive condition that affects 2. 0000000 Americans. This is a lung disease usually caused by smoking. Usually it is a violation of the walls of air sacs of lungs, causing them to become abnormally enlarged. This abnormally enlarged air bags are bad for oxygenation. In addition, they cause small airways that carry air in and air sacs to collapse during respiration, particularly exhalation. This abnormally enlarged air sacs easily fill with air during inspiration, but they lose their ability to clear the lungs via the small airways during exhalation. This is reminiscent of airway obstruction, and some use the term chronic obstructive pulmonary disease to describe emphysema. Problem easy filling and emptying of the poor light causes progressive hyperexpansion light leads to poor mechanics of breathing. This is in addition to poor oxidation opportunity emphysema makes more and more difficult to breathe. Many people who suffer from emphysema in the lungs of who suffered more others. This discovery led to the creation of a surgical approach to the treatment of emphysema. Lung volume reduction surgery (LVRS) is a procedure that removes about 20-35% does not function, space occupying lung tissue from each lung.
By reducing the amount of light, more light and the surrounding muscles (intercostals and diaphragm) can work more efficiently. This makes breathing easier and helps patients achieve better quality of life. It is important that this operation is only for people who can benefit from the procedure with minimal risk of complications. A good candidate for LVRS is the one who gave up smoking for 4 months and disabling emphysema, despite full compliance with optimal medical therapy. The patient should be able to participate in pulmonary rehabilitation program before and after surgery. Any other condition that the candidate can be well managed and should not represent an unacceptable risk of complications from the procedure. Most importantly, the patient should have the structure of emphysema that is amenable to surgical treatment. This means that there are space occupying, poorly functioning area of the lungs that can be removed to improve lung function. Images of research, including chest X-ray, computed tomography and lung perfusion studies done to determine this. National judicial treatment of emphysema (net) were prospective, randomized, multicenter study which compared the results of LVRS to medical therapy, which showed that there are 3 groups of patients who seek to benefit from LVRS. The following groups of patients are candidates for LVRS:
patients with predominantly upper lobe emphysema and low exercise tolerance. These patients have improved survival and functional results after LVRS compared with drug therapy. Patients with predominantly upper lobe emphysema and high exercise. These patients improved functional results after LVRS but no difference in survival compared with drug therapy. Patients with non-upper lobe emphysema and low exercise tolerance. In these patients, improved survival after LVRS but no difference in survival compared with drug therapy. NETT also identified patients unlikely to benefit from LVRS and have a high risk of death after surgery. The following groups of patients are not candidates for LVRS:
patients with non-upper lobe emphysema and high exercise. In patients with very poor lung function (FEV1 20% or less than predicted) and either a uniform distribution of emphysema on CT or extremely poor carbon monoxide lasix 15 mg diffusion capacity (DLCO 20% or less than forecast). To optimize physical activity and improved early postoperative recovery, patients should take part in 6 to 10 weeks of pulmonary rehabilitation program before surgery. The operation requires general anesthesia and can be done through an incision or breastbone or small cuts thoracic surgery using video. Special surgical stapler is used to remove diseased lung tissue and seal blood leaks were light and air. Immediately after the procedure, patients wake up from general anesthesia and allows you to breathe independently. Pain medicine given through the epidural catheter to control postoperative discomfort. Drainage pipes are in the chest to drain the excess air or fluid from the chest after surgery. They removed as soon as air and fluid leakage stops. Physical therapy restored early recovery during hospitalization. Patients discharged from hospital once the patient is mobile, tolerance normal diet and drainage tubes were removed. There are significant risks associated with LVRS because of poor lung function line. The main risks of this procedure are:
long air leakage is the most common complication after LVRS. About 40% of patients with this problem. Some patients actually return home from breast leakage in place for several days to help cope with this. Pneumonia (15%) can occur in emphysema patients, especially in patients with recurrent attacks
Anyone who meets the general criteria may be considered for formal assessment. This will entail a thorough analysis of case histories of patients, medical examination, pulmonary function studies and instrumental methods of investigation. These images can be drawn from the study your referring physician or the hospital of the University of Southern California. If these preliminary studies fulfill the necessary criteria, further evaluations will be conducted as needed. When all necessary information has been collected, the patient will be discussed in USC cardiothoracic surgery light Denial Management Conference to discuss LVRS should be offered to the patient. In some cases, patients may be better candidates for transplantation of lungs, which will be offered in those cases. For consideration of LVRS. .
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