肺気腫に対する外科治療

Surgical Treatment of Emphysema

肺気腫に対する外科治療には，肺容量減量手術（LVRS）と肺移植がある．胸部外科医が重症肺気腫患者をみた場合，どちらかの外科治療の適応があるかどうかを考える必要がある．肺移植やLVRSの適応について，症例を提示し，考える．

Lung volume reduction surgery （LVRS） and lung transplantation are surgical treatment options for emphysema. While lung transplantation is generally considered to be the final treatment option because of its high risk, it can be considered as the first option in patients aged ＜60 years with severe respiratory failure and ％FEV1.0 ＜20％. Patients with ％FEV1.0 20-45％ and computed tomography （CT） findings of heterogeneously distributed emphysema, with better preserved lung tissue in some areas compared with other areas, may be suitable candidates for LVRS. In particular, patients with predominantly upper lung zone emphysema are more likely to benefit from LVRS than other patients. In this report, we describe three emphysema patients who underwent LVRS, and then discuss the essential factors that should be taken into consideration during candidate selection for LVRS or lung transplantation.