Tschopp J M, Boutin C, Astoul P, Janssen J P, Grandin S, Bolliger C T, Delaunois L, Driesen P, Tassi G, Perruchoud A P
Centre Valaisan de Pneumologie, Montana, Switzerland.
Eur Respir J. 2002 Oct;20(4):1003-9. doi: 10.1183/09031936.02.00278202.
Simple thoracoscopic talcage (TT) is a safe and effective treatment of primary spontaneous pneumothorax (PSP). However, its efficacy has not previously been estimated in comparison with standard conservative therapy (pleural drainage (PD)). In this prospective randomised comparison of two well-established procedures of treating PSP requiring at least a chest tube, cost-effectiveness, safety and pain control was evaluated in 108 patients with PSP (61 TT and 47 PD). Patients in both groups had comparable clinical characteristics. Drainage and hospitalisation duration were similar in TT and PD patients. There were no complications in either group. The immediate success rate was different: after prolonged drainage (>7 days), 10 out of 47 PD patients, but only 1 out of 61 TT patients required a TT as a second procedure. Total costs of hospitalisation including any treatment procedure were not significantly different between TT and PD patients. Pain, measured daily by visual analogue scales, was statistically higher during the first 3 days in TT patients but not in those patients receiving opiates. One month after leaving hospital, there was no significant difference in residual pain or full working ability: 20 out of 58 (34%) versus 10 out of 47 (21%) and 36 out of 61 (59%) versus 26 out of 39 (67%) in TT versus PD groups, respectively. After 5 yrs of follow-up, there had been only three out of 59 (5%) recurrences of pneumothorax after TT, but 16 out of 47 (34%) after conservative treatment by PD. Cost calculation favoured TT pleurodesis especially with regard to recurrences. In conclusion, thoracoscopic talc pleurodesis under local anaesthesia is superior to conservative treatment by chest tube drainage in cases of primary spontaneous pneumothorax that fail simple aspiration, provided there is efficient control of pain by opioids.
单纯胸腔镜滑石粉胸膜固定术（TT）是治疗原发性自发性气胸（PSP）的一种安全有效的方法。然而，此前尚未将其与标准保守治疗（胸腔引流（PD））进行疗效评估。在这项对108例PSP患者（61例行TT，47例行PD）进行的两种成熟的至少需要一根胸管的PSP治疗方法的前瞻性随机比较中，评估了成本效益、安全性和疼痛控制情况。两组患者的临床特征具有可比性。TT组和PD组患者的引流时间和住院时间相似。两组均无并发症发生。即时成功率有所不同：在长时间引流（>7天）后，47例PD患者中有10例，但61例TT患者中只有1例需要再次行TT手术。包括任何治疗程序在内的住院总费用在TT组和PD组患者之间无显著差异。通过视觉模拟量表每日测量的疼痛程度，TT组患者在最初3天内在统计学上更高，但接受阿片类药物治疗的患者则不然。出院1个月后，残留疼痛或完全工作能力方面无显著差异：TT组58例中有20例（34%），PD组47例中有10例（21%）；TT组61例中有36例（59%），PD组39例中有26例（67%）。随访5年后，TT术后气胸复发仅59例中有3例（5%），而PD保守治疗后47例中有16例（34%）。成本计算显示TT胸膜固定术更具优势，尤其是在复发方面。总之，在单纯穿刺抽吸失败的原发性自发性气胸病例中，局部麻醉下的胸腔镜滑石粉胸膜固定术优于胸腔闭式引流的保守治疗，前提是通过阿片类药物有效控制疼痛。
