Current Surgical Therapy for Bronchiectasis |
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Authors: | Mahmoud Ashour Khaled Al-Kattan Mohamad A Rafay Khalid F Saja Waseem Hajjar Abdul Rahman Al-Fraye |
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Institution: | (1) Division of Surgery, King Khalid University Hospital, College of Medicine, King Saud University, PO Box 7805, Riyadh 11472, Kingdom of Saudi Arabia, SA;(2) Division of Paediatrics, King Khalid University Hospital, College of Medicine, King Saud University, PO Box 7805, Riyadh 11472, Kingdom of Saudi Arabia, SA |
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Abstract: | The ideal classification system for bronchiectasis continues to be debated. As an alternative to the present morphologic
classification, a hemodynamic-based functional classification is proposed. This study examines the rationale for and outcome
of surgery based on this classification in patients with unilateral or bilateral bronchiectasis. Between July 1987 and January
1997 the morphologic and hemodynamic features in 85 bronchiectatic patients were examined: 18 with bilateral bronchiectasis
and 67 with unilateral disease. A policy of unilateral lung resection of the nonperfused bronchiectasis and preservation of
the perfused type was adopted in all patients. The mean age at operation was 29.4 ± 9.7 years (range 6–55 years) with a mean
follow-up period of 45.2 ± 21.0 months (range 2–120 months). Left-sided predominance of bronchiectasis was evident in this
series both in frequency and severity. In those with unilateral disease, bronchiectasis was left-sided in 49 (73.1%) patients
and right-sided in 18 (26.9%). The left lung was totally bronchiectatic in 11 (16.4%) patients and the right in 3 (4.4%).
Moreover, among the patients with bilateral bronchiectasis, 14 of 18 (77.7%) patients had the left lung more severely involved.
Based on the morphologic and hemodynamic features in the investigated patients, two types of bronchiectasis were recognized:
a perfused type with intact pulmonary artery flow and a nonperfused type with absent pulmonary artery flow. Lobectomy was
performed in 55 patients, basal segmentectomy and preservation of the apical segment in 16, and pneumonectomy in 14. There
was no mortality in this series. Altogether 63 patients (74.1%) achieved excellent results, 19 (22.4%) scored good results,
and 3 (3.5%) patients had not benefited from surgery at last follow-up. In the face of the general criticism of the traditional
morphologic classification, the proposed classification not only predicts whether the involved lung will have a measure of
respiratory function with regard to gas exchange but reflects the degree of severity of the disease process. Thus the question
of which side to resect and which to preserve is defined more precisely. This classification was found to be logical, physiologically
sound, and of proven benefit. |
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