Loubani M, Lynch V
Thoracic Surgery Unit, St. Vincent's Hospital Elm Park, Dublin, Ireland.
Respir Med. 2000 Sep;94(9):888-90. doi: 10.1053/rmed.2000.0862.
The introduction of video assisted thoracoscopic surgery (VATS) has led to the development of several endoscopic options for the management of spontaneous pneumothorax. We describe here our experience in the management of primary spontaneous pneumothorax (SP). We carried out 58 VATS procedures on 55 patients during the period 1993-95. There were six conversions to open thoracotomy because of dense adhesions in five patients and a large apical bulla of 20 cm in one. These patients were excluded from the study. The remaining 49 patients underwent 52 VATS procedures. There were 37 males and 12 females with a median age of 23 (range: 15-71) years. The indications for surgery were persistent SP for more than 5 days in 21 (40%), and recurrent SP in 31 (60%). Twenty-six procedures (25 patients) consisted of bullectomy alone (group 1; 1/1/93-30/9/94) and the next 26 procedures (24 patients) included chemical pleurodesis with 2 g of Acromycin (Lederle) in 10 ml of 0.9 normal saline (group 2; 1/10/94-31/12/95). Both groups had a mean follow up of 38 months (range: 36-40). Mean postoperative chest drainage in group 2 (3.1 +/- 1.09) was significantly shorter than in group 1 (4.7 +/- 1.0). Group 2 patients also had a shorter hospital stay (4.8 /- 1.08 vs. 6.76 +/- 1.09). There were five (20%) recurrences in group 1 while only one (4%) occurred in group 2. In view of these results we recommend the routine use of Acromycin pleurodesis in addition to thoracoscopic bullectomy.
电视辅助胸腔镜手术（VATS）的引入促使了几种用于治疗自发性气胸的内镜治疗方法的发展。在此，我们描述我们在原发性自发性气胸（SP）治疗方面的经验。1993年至1995年期间，我们对55例患者实施了58例VATS手术。由于5例患者存在致密粘连以及1例患者有一个20厘米的巨大肺尖大疱，有6例转为开胸手术。这些患者被排除在研究之外。其余49例患者接受了52例VATS手术。其中男性37例，女性12例，中位年龄为23岁（范围：15 - 71岁）。手术指征为21例（40%）持续性SP超过5天，31例（60%）复发性SP。26例手术（25例患者）仅行肺大疱切除术（第1组；1993年1月1日 - 1994年9月30日），接下来的26例手术（24例患者）包括在10毫升0.9%生理盐水中加入2克放线菌素（Lederle）进行化学胸膜固定术（第2组；1994年10月1日 - 1995年12月31日）。两组的平均随访时间均为38个月（范围：36 - 40个月）。第2组的平均术后胸腔引流时间（3.1±1.09天）明显短于第1组（4.7±1.0天）。第2组患者的住院时间也更短（4.8±1.08天对6.76±1.09天）。第1组有5例（20%）复发，而第2组仅1例（4%）复发。鉴于这些结果，我们建议除了胸腔镜下肺大疱切除术外，常规使用放线菌素胸膜固定术。
