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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/11/03 17:38:10」(JST)

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Lung volume reduction surgery, or LVRS, can improve the quality of life for certain COPD and emphysema patients. Parts of the lung that are particularly damaged by emphysema are removed, allowing the remaining, relatively good lung to expand and work better.

Conventional LVRS involves resection of the most severely affected areas of emphysematous, non-bullous lung (aim is for 20-30%). This is a surgical option involving a mini-thoracotomy for patients suffering end stage COPD due to underlying emphysema, and can improve lung elastic recoil as well as diaphragmatic function.

Increased mortality, contraindicating the procedure, is noted in patients that have both:

FEV₁ < 20%
DL_CO < 20% or diffusely distributed emphysema on a CT scan

The National Emphysema Treatment Trial (Fishman et al., 2003) was a large multicentre study (N = 1218) comparing LVRS with medical treatment. Results suggested that:

There was no overall survival advantage in the LVRS group, except for mainly upper-lobe emphysema + poor exercise capacity, and
Significant improvements were seen in exercise capacity in the LVRS group.

Possible complications (Hopkins et al., 2006):

Mortality at 90 days of 1.8% and survival at 3 and 5 years of 91.1% and 76% respectively.
Prolonged air leak (mean duration post surgery until all ICC's removed is 10.9 +/- 8.0 days)

References

National Emphysema Treatment Trial Research Group; Alfred Fishman; Fernando Martinez; Keith Naunheim; Steven Piantadosi; Robert Wise; Andrew Ries; Gail Weinmann; Douglas E. Wood (2003-05-22). "A Randomized Trial Comparing Lung-Volume–Reduction Surgery with Medical Therapy for Severe Emphysema". New England Journal of Medicine (Boston: Massachusetts Medical Society) 348 (21): 2059–2073. doi:10.1056/NEJMoa030287. ISSN 0028-4793. OCLC 1587974. PMID 12759479. Retrieved 2009-07-13.
Hopkins, P. M.; H. Seale; J. Walsh; R. Tam; F. Kermeen; S. Bell; K. McNeil (February 2006). "Long term results post conventional lung volume reduction surgery exceeds outcome of lung transplantation for emphysema". Journal of Heart and Lung Transplantation (St. Louis, Missouri: Mosby-Year Book) 25 (2): S61. doi:10.1016/j.healun.2005.11.053. ISSN 1053-2498. OCLC 22486861. |access-date= requires |url= (help)

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1. 慢性閉塞性肺疾患（COPD）における肺容量減少術 lung volume reduction surgery in copd
2. 慢性閉塞性肺疾患（COPD）の新規治療法：肺気腫の気管支鏡治療 emerging therapies for copd bronchoscopic treatment of emphysema
3. 安定した慢性閉塞性肺疾患（COPD）のマネージメント management of stable chronic obstructive pulmonary disease
4. 慢性閉塞性肺疾患（COPD）における巨大肺嚢胞の評価および内科的マネージメント evaluation and medical management of giant bullae in copd
5. 肺切除術前評価 preoperative evaluation for lung resection

English Journal

Two-Year Follow-up in Patients Treated With Emphysematous Lung Sealant for Advanced Emphysema.

Kramer MR, Refaely Y, Maimon N, Rosengarten D, Fruchter O.AbstractEndoscopic lung volume-reduction therapy for emphysema has been associated with therapeutic responses smaller in magnitude and less durable than surgical volume reduction (LVRS). Bronchoscopic emphysematous lung sealant (ELS) therapy has been shown to produce improvements in pulmonary function similar to surgery at 1 year. This case series summarizes safety and efficacy data of all patients from the initial ELS study out to 2 years. Between 1 and 2 years, there were three all-cause adverse events requiring hospitalization. One patient went on to successful lung transplant. Improvements relative to baseline in spirometry (change in FEV1: + 14.3 ± 33.1%; change in FVC: + 5.8 ± 23.2%) and diffusing capacity (change in diffusing capacity of the lung for carbon monoxide: + 10.6 ± 20.6%) were observed at 2 years. An exponential model fit to FEV1 data at 6, 12, 18, and 24 months predicted improvements from a baseline of > 5% out to 4.1 years, similar to what has been reported following surgery. This report confirms long-term safety and efficacy following ELS therapy in advanced emphysema. Studies in a larger cohort are needed to define the role of ELS therapy in the treatment algorithm of patients with this condition.
Chest.Chest.2013 Nov 1;144(5):1677-80. doi: 10.1378/chest.13-0446.
Endoscopic lung volume-reduction therapy for emphysema has been associated with therapeutic responses smaller in magnitude and less durable than surgical volume reduction (LVRS). Bronchoscopic emphysematous lung sealant (ELS) therapy has been shown to produce improvements in pulmonary function simil
PMID 24189860

Long-term survival analysis of the canadian lung volume reduction surgery trial.

Agzarian J, Miller JD, Kosa SD, Malthaner R, Tan L; Canadian Volume Reduction Surgery Study Group.SourceDivision of Thoracic Surgery, McMaster University, St. Joseph's Healthcare, Hamilton, Ontario, Canada.
The Annals of thoracic surgery.Ann Thorac Surg.2013 Oct;96(4):1217-22. doi: 10.1016/j.athoracsur.2013.04.077. Epub 2013 Jul 26.
BACKGROUND: The Canadian Lung Volume Reduction Surgery (CLVRS) trial was a multicentered randomized controlled trial that concluded that lung volume reduction surgery improves functional status and health-related quality of life (for at least 2 years) in selected patients with advanced emphysema.MET
PMID 23895890

Erythrocyte osmotic resistance recovery after lung volume reduction surgery.

Mineo TC, Sellitri F, Tacconi F, Ambrogi V, Tamburrini A, Mineo D.SourceThoracic Surgery Division and Department, Emphysema Center, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata University, Rome, Italy.
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.Eur J Cardiothorac Surg.2013 Sep 25. [Epub ahead of print]
OBJECTIVES: Alteration of erythrocyte osmotic resistance, with increment of reticulocytes, is common in emphysema. This fragility is probably due to an altered fatty acid membrane composition from lipid peroxidation, a reaction triggered by the disease-related increment of reactive oxidative species
PMID 24067747

Japanese Journal

閉塞性肺疾患合併肺癌例に対する肺切除 (特集合併症を有する胸部外科手術) -- (呼吸器領域)

西川滋人,千原幸司
胸部外科 65(8), 706-713, 2012-07-00
NAID 40019384235

重症肺気腫を合併した胃癌患者に対する胃癌術前LVRS (Lung Volume Reduction Surgery) の選択

山瀬裕美,鈴木聡
日本臨床麻酔学会誌 = The Journal of Japan Society for Clinical Anesthesia 31(2), 314-317, 2011-03-15
NAID 10027912354

非薬物療法肺気腫に対する外科療法・内視鏡療法 (COPDの治療・管理update) -- (安定期の管理)

伊達洋至
日本胸部臨床 70(-), S121-127, 2011-00-00
NAID 40018966291

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