L / year, slightly below the range (48 ...

The first result of this study, with no one through observation concerns the lack of early postoperative mortality

and if acceptable total early and late mortality. As a further result, new blisters appear on the site

in bullectomy and no residual small blisters were expanded during the next period . These results show that the

planned operation, regardless of type of surgical approach chosen is safe both in short and long term >>. << In particular, death occurs in our study, only patients in which blisters are surrounded by diffuse emphysema (27. 8%),

, to the most seriously ill reason. We understand that the lack of early postoperative mortality in patients in our series may be partly related to the design >> < <research, which included patients who underwent surgery in an emergency situation (

such as the severe pneumothorax), but the mortality rate due to respiratory failure within the first year after surgery was also acceptable lasix heart failure

low (7. 3%). Overall, early mortality in our series is in accord with mortality that ranges

0 to 22. 5% at the lower range, which were described in the literature, and it >> << similar to the weighted average of mortality 8. 0% calculated by Snyder

in 262 patients with giant bullectomy, and not a giant bull. Overall mortality was quite low (12. 2%), even if the

to say, that comparison with data in the literature is not easy, as many studies of retrospective design report

incomplete and conflicting data, do not have a predefined time intervals between the patients, and often include >> << patients with giant bullae and GBE. According to our data, however, were obtained in a prospective way serial number patients seen annually

with clinical and functional assessment within 5 years of observation. Therefore, the data are comparable with those reported recently Shypper

etc. in modern series. Another important result of our study is that routine surgery for the treatment of GBE improves clinical and functional conditions

treated patients and is better preserved in long term. In fact, most patients experienced early and late

improve breathlessness. degree of dyspnea, as measured by mBMRC shortness of breath, decreased markedly soon after surgery >> <<'s all down to the fourth year of observation, when it increased more in the fifth year of training, but remained below

observed before surgery. This highlights the differences between patients who undergo LVRS, which help

from shortness of breath persists only 1 or 2 years after surgery and a very small proportion of patients who undergo surgery >> << (15. 0% to 61. 1%, respectively, in our study), which still show improvement after 5 years of observation.) increases significantly with n ' fifth year of observation, and directly related to the TGV (TGV and percent predict)

significant decrease after surgery and remained unchanged throughout the follow-up. Therefore, the constant value >> << TGV (TGV and percent forecast) after the initial decrease supports the observation that no new bullae appeared in the

next period and may be considered to be as a marker of favorable outcome. In addition, dyspnea remained strictly

connected to the bronchial obstruction, as shown in a consistent inverse correlation with FEV, FEV

percent predicted and FEV

/ VC relationship and, therefore, was associated mechanical effects of bullectomy. Indeed, removing bull unpacks

easy operation and ipsilateral bronchus. On the other hand, FEV

percent anticipate improvement in the second year of observation, when they grow on average by 0. 5 L with respect to the base >>. << Then, FEV

decreases approximately 200 ml in the third year of observation and then remained fairly stable until the end of the observation period. Considering the difference between the second and fifth year of observation, we observed a decrease in the average of 46

ml / year, slightly below the range (48 to 91 ml / year) observed in patients with COPD. At the end of the fifth year of observation, FEV

still clearly higher than the basic values ​​that reproduce the above behavior dyspnea. Patients who presented with diffuse emphysema at inclusion in the study (group B) were on average more severely ill than patients without

diffuse emphysema (group A) and was the only factor for mortality. Minor differences in static lung volumes may

observed in patients with two groups who completed the follow-up. Although the behavior of dyspnea severity was similar >> << into two groups, static lung volumes (ie

total lung capacity, TGV, residual volume, FRC) was lower in the group at every step further and D

increased more. There were no significant differences in arterial gas parameters in the blood. Thus, on average >> << suggests that patients in both groups benefit from the transaction, although to varying degrees and in different rooms

, people. As airflow limitation patients in group A had an average annual decrease in FEV

total 25 ml while in group B was the average annual decline of 83 ml (eg, progressive functional impairment that was similar in patients with severe COPD). In particular, the group of patients increased FEV

for the first 2 years after bullectomy was over three times lower for the next 3 years. In the group of patients B,

This growth was almost completely offset in subsequent years, which decreases occurred that was similar to

those that occur in patients who underwent LVRS, which inevitably raises questions about when patients should undergo surgery. In calculating the overall correlation between bullectomy and LVRS of the consequences of such an operation at the clinic and

lung function, we can show that the main clinical and functional status of patients who underwent >> << bullectomy for GBE, taken as a whole or undergo LVRS for diffuse emphysema differ markedly. In fact, patients who undergo

LVRS have a higher average age above the average score breathlessness and decreased Pa, D, and FEV

values ​​compared with those undergoing bullectomy. In addition, these patients show surprisingly different mortality rates, as shown by Gehlbach, etc.

of 26 patients observed for 5 years by Naunheim et al

of 330 patients after undergoing unilateral LVRS and in 343 patients after bilateral LVRS observed

for 3 years and, more recently, the National Judicial treatment of emphysema. However, the early functional changes after the surgery qualitatively similar. In particular, in both patients who underwent

bullectomy and in those who underwent LVRS, dyspnea decreases and FEV

increases during the first 6 months after surgery. This improvement more and more consistently in the first group, where it is stored for at least 5 years, while the progressive >> << impaired lung function, as reported, on average, within 1 year after the patient undergoes LVRS. However, in 2003

research has been done in a strictly selected group of patients, LVRS as a result of the positive effects to assess dyspnea and quality

life, at least 5 years after surgery. In conclusion, the results show that giant bullectomy fairly safe method that improves the early and late

, clinical and functional status of patients is improving, however, almost completely abolished after 5 years

patients with primary diffuse emphysema. .