Horio H, Nomori H, Kobayashi R, Naruke T, Suemasu K
Department of Thoracic Surgery, Saiseikai Central Hospital, 1-4-17, Mita, Minato-ku, Tokyo 108-0073, Japan.
Surg Endosc. 2002 Apr;16(4):630-4. doi: 10.1007/s00464-001-8232-5. Epub 2002 Jan 9.
Bullectomy for primary spontaneous pneumothorax has been associated with high postoperative recurrence rates when video-assisted thoracoscopic surgery (VATS) has been used rather than thoracotomy. The aim of this study was to evaluate the efficacy and identify the disadvantages, if any, of adding pleurodesis to VATS bullectomy to prevent recurrent pneumothorax.
Fifty-three patients who underwent VATS bullectomy with additional pleurodesis for pneumothorax after November 1996 and 50 who underwent VATS bullectomy alone before October 1996 were compared retrospectively in terms of intraoperative factors and postoperative chest pain, pulmonary function, and pneumothorax recurrent rates. Pleurodesis was achieved by electrocauterizing the upper surface of the parietal pleura in a patchy fashion.
There were no significant differences between the additional pleurodesis group and the bullectomy alone group in terms of age, sex, operating time, intraoperative bleeding, number of resected bullae, duration of chest drainage, or volume of fluid drained. Postoperative chest pain and pulmonary function were also similar in both groups. A recurrent pneumothorax occurred in one patient (1.9%) in the additional pleurodesis group; this recurrence rate was significantly lower than that for the bullectomy alone group (eight patients, 16%; p = 0.029). Although the mean postoperative follow-up period was considerably shorter in the additional pleurodesis group (38 months [range, 26-49]) than in the bullectomy alone group (63 months [range, 50-72] ), eight (89%) of all nine recurrences occurred within 26 months of surgery-i.e., within the minimum follow-up period for the additional pleurodesis group.
Pleurodesis is a minimally invasive technique that is effective in preventing postoperative recurrences of pneumothorax when added to VATS bullectomy. Additional pleurodesis has no disadvantages vs bullectomy alone in terms of worsening postoperative chest pain or pulmonary function.
在原发性自发性气胸的治疗中，与开胸手术相比，采用电视辅助胸腔镜手术（VATS）进行肺大疱切除术时术后复发率较高。本研究的目的是评估在VATS肺大疱切除术中加用胸膜固定术预防气胸复发的疗效，并确定其是否存在缺点。
回顾性比较1996年11月后接受VATS肺大疱切除术并加用胸膜固定术治疗气胸的53例患者和1996年10月前仅接受VATS肺大疱切除术的50例患者的术中因素、术后胸痛、肺功能及气胸复发率。胸膜固定术通过点状电灼壁层胸膜上表面来实现。
加用胸膜固定术组与单纯肺大疱切除术组在年龄、性别、手术时间、术中出血、切除肺大疱数量、胸腔引流时间或引流量方面无显著差异。两组术后胸痛和肺功能也相似。加用胸膜固定术组有1例患者（1.9%）发生气胸复发；该复发率显著低于单纯肺大疱切除术组（8例患者，16%；p = 0.029）。尽管加用胸膜固定术组的术后平均随访期（38个月[范围，26 - 49个月]）明显短于单纯肺大疱切除术组（63个月[范围，50 - 72个月]），但9例复发患者中有8例（89%）在术后26个月内复发，即在加用胸膜固定术组的最短随访期内。
胸膜固定术是一种微创技术，在VATS肺大疱切除术中加用该技术可有效预防气胸术后复发。与单纯肺大疱切除术相比，加用胸膜固定术在加重术后胸痛或肺功能方面并无缺点。
