État actuel de la chirurgie de réduction du volume pulmonaire dans l'emphysème

Pulmonary volume reduction surgery consists of the resection of inflated non-functional part of the lung interacting with the optimal function of the surrounding pulmonary parenchyma. Its purpose is to reduce dyspnea and improve quality of life in a selected population of emphysematous patients. Its action mainly results from an increase of the elastic recoil of the lung and of gas exchanges by resection of area with high ventilation-perfusion rapports. It is a palliative therapeutic option but the benefits begin to be documented by randomized studies. The involvement of each candidate in a pre- and postoperative multidisciplinary program is a prerequisite. Today, there is not yet criteria well defined to exclude or include patient for this surgery. However, the literature data permits to establish recommendations. Lung volume reduction surgery is not possible in some patients. Recent publications suggest an alternative approach (apart from the lung transplantation) such as the endoscopic lung volume reduction, in some of them.