Ohno K, Miyoshi S, Minami M, Akashi A, Maeda H, Nakagawa K, Matsumura A, Nakamura K, Matsuda H, Ohashi S
Thoracic Surgery Study Group, Osaka University (TSSG), Osaka, Japan.
Jpn J Thorac Cardiovasc Surg. 2000 Dec;48(12):757-60. doi: 10.1007/BF03218248.
We retrospectively evaluated the results of video-assisted thoracoscopic surgery for primary spontaneous pneumothorax and recurrence.
A series of 424 patients with primary spontaneous pneumothorax were treated by video-assisted thoracoscopic surgery-289 with an ipsilateral recurrent episode, 88 with persistent air leakage for 7 days or longer, 34 with a contralateral episode, 9 with hemopneumothorax, and 4 with tension pneumothorax. The commonest management was stapling of an identified bleb, undertaken in 375 patients (88.4%). Pleural abrasion was conducted in 250 (59.0%), but the abraded area was one-third or less of the thoracic cavity in 187 (74.8%).
No operative deaths occurred. Revisional thoracotomy was required in 1 patient with postoperative bleeding and another with incomplete postoperative lung reexpansion; 26 had prolonged air leakage, but none required revisional thoracotomy. During a mean follow-up of 31.4 months, ipsilateral pneumothorax recurred in 40 patients (9.4%), with 26 (65.0%) having recurrence within 1 year postoperatively. A video-assisted thoracoscopic surgery was conducted again in 8, and thoracotomy in 14.
The ipsilateral recurrence of primary spontaneous pneumothorax after video-assisted thoracoscopic surgery was high at 9.4%. If video-assisted thoracoscopic surgery is to be considered as a treatment for spontaneous pneumothorax, we must therefore reduce postoperative ipsilateral recurrence by training practitioners not to overlook blebs during the procedure and/or consider widening the area of pleurodesis.
我们回顾性评估了电视辅助胸腔镜手术治疗原发性自发性气胸及其复发情况的结果。
424例原发性自发性气胸患者接受了电视辅助胸腔镜手术治疗，其中289例有同侧复发性发作，88例持续漏气7天或更长时间，34例有对侧发作，9例有血气胸，4例有张力性气胸。最常见的处理方法是对确定的肺大疱进行缝合，375例患者（88.4%）采用了该方法。250例（59.0%）进行了胸膜摩擦，但187例（74.8%）摩擦面积为胸腔的三分之一或更小。
无手术死亡病例。1例术后出血和另1例术后肺复张不全的患者需要再次开胸手术；26例有持续性漏气，但均无需再次开胸手术。平均随访31.4个月期间，40例患者（9.4%）同侧气胸复发，其中26例（65.0%）在术后1年内复发。8例再次接受电视辅助胸腔镜手术，14例接受开胸手术。
电视辅助胸腔镜手术后原发性自发性气胸同侧复发率较高，为9.4%。因此，如果将电视辅助胸腔镜手术视为自发性气胸的一种治疗方法，我们必须通过培训医生在手术过程中不忽视肺大疱和/或考虑扩大胸膜固定术的面积来降低术后同侧复发率。
