原发性气胸的胸膜切除术：是否需要广泛胸膜切除术？

Pleurectomy in primary pneumothorax: is extensive pleurectomy necessary?

作者信息

Leo F, Pastorino U, Goldstraw P

机构信息

Department of Thoracic Surgery, European Institute of Oncology, Milano, Italy.

出版信息

J Cardiovasc Surg (Torino). 2000 Aug;41(4):633-6.

PMID:11052298

Abstract

BACKGROUND

The aim of the study was to evaluate the results of parietal pleurectomy in patients with primary spontaneous pneumothorax comparing extensive pleurectomy performed by thoracotomy versus more limited pleurectomy performed by VATS.

METHODS

Records of the patients operated on for primary pneumothorax at Royal Brompton Hospital from January 1994 to April 1997 were retrospectively reviewed. A follow-up questionnaire was sent to patients asking about further pneumothorax and the presence of long-term chest problems on the operated side. A statistical uni- and multivariate analysis was performed searching predictors for postoperative complications, recurrence and chronic chest problems.

RESULTS

Thirty-six patients underwent extensive pleurectomy through a limited postero-lateral thoracotomy (40%, group A), 54 patients had a limited pleurectomy (60%, group B), 50 by VATS and 4 by axillary thoracotomy. Overall, 11 patients had postoperative complications (12.2%). In group A, 4 patients (11.1%) had complications (2 reoperation, 2 air leak >7 days). In group B, 7 patients (12.9%) had complications (1 reoperation, air leak >7 days, 1 wound infection). Two patients experienced recurrent ipsilateral pneumothorax after surgery, both belonging to group B (overall recurrence rate 2.5%, group B 4.1%). Thirteen patients in both groups (respectively 41.9% in group A and 27% in group B) admitted chest problems on the operated side. From statistical analysis, "indication" resulted a predictor of complications (p=0.03) and "thoracotomy" a predictor of long-term chest problems (p=0.03).

CONCLUSIONS

Many theoretical advantages of limited VATS pleurectomy have still to be confirmed and it is reasonable to use it in uncomplicated primary pneumothorax. The superb exposure obtained with thoracotomy and the superiority of extensive pleurectomy in terms of recurrence indicate this approach in case of complicated pneumothorax or when long-term security is of paramount importance.

摘要

背景

本研究旨在评估经胸廓切开术进行的广泛性胸膜切除术与通过电视辅助胸腔镜手术（VATS）进行的更有限的胸膜切除术相比，原发性自发性气胸患者行壁层胸膜切除术的效果。

方法

回顾性分析1994年1月至1997年4月在皇家布朗普顿医院接受原发性气胸手术患者的记录。向患者发送随访问卷，询问其是否再次发生气胸以及手术侧是否存在长期胸部问题。进行单因素和多因素统计分析，寻找术后并发症、复发及慢性胸部问题的预测因素。

结果

36例患者通过有限的后外侧胸廓切开术接受了广泛性胸膜切除术（40%，A组），54例患者接受了有限的胸膜切除术（60%，B组），其中50例通过VATS，4例通过腋下胸廓切开术。总体而言，11例患者出现术后并发症（12.2%）。A组中，4例患者（11.1%）出现并发症（2例行再次手术，2例漏气超过7天）。B组中，7例患者（12.9%）出现并发症（1例行再次手术，漏气超过7天，1例伤口感染）。2例患者术后出现同侧复发性气胸，均属于B组（总体复发率2.5%，B组4.1%）。两组中有13例患者（A组分别为41.9%，B组为27%）承认手术侧存在胸部问题。经统计分析，“适应证”是并发症的预测因素（p = 0.03），“胸廓切开术”是长期胸部问题的预测因素（p = 0.03）。