Bagan Patrick, Le Pimpec Barthes Françoise, Assouad Jalal, Souilamas Redha, Riquet Marc
Service de Chirurgie Thoracique, Hôpital Européen Georges Pompidou, Paris, France.
Ann Thorac Surg. 2003 Feb;75(2):378-81; discusssion 381. doi: 10.1016/s0003-4975(02)04320-5.
Catamenial pneumothorax is a rare entity characterized by recurrent accumulation of air in the thoracic space during menstruation. Catamenial pneumothorax is also associated with a high rate of postoperative recurrence. The aim of this study was to discuss the etiology and to determine the optimal surgical treatment of this entity.
From December 1991 to September 2000, 10 patients with catamenial pneumothorax were treated at our institution. Median age at time of operation was 37 years (range, 21 to 44 years). We retrospectively evaluated the pathologic findings, the operation performed, and the results in all patients. The mean follow-up was 55.7 months.
Pleurodesis alone was performed in 5 patients and an associated diaphragmatic procedure was performed in 5 patients. In 5 patients, no diaphragmatic anomaly was discovered: 3 experienced one or more recurrences and all still suffer from chronic catamenial chest pain. Hormonal therapy temporarily improved outcome for 6 months in 2 patients. On the contrary, in 5 patients surgical pleurodesis was associated with the repair of diaphragmatic defects (simple closure or coverage by a polyglactin mesh): these patients experienced no recurrence (n = 0/5, p = 0.0016) and no subsequent catamenial chest pain.
The postoperative outcome is influenced by the diagnosis of diaphragmatic defects with or without endometriosis. Surgical treatment should be accomplished during menstruation for an optimal visualization of pleurodiaphragmatic endometriosis. Because diaphragmatic lesion is frequent and may be occult, we propose the systematic coverage of the diaphragmatic surface by a polyglactin mesh to prevent catamenial pneumothorax recurrence even when the diaphragm appears normal.
月经性气胸是一种罕见的病症，其特征为在月经期间胸腔反复积气。月经性气胸术后复发率也很高。本研究的目的是探讨其病因并确定该病症的最佳手术治疗方法。
1991年12月至2000年9月，我院共治疗了10例月经性气胸患者。手术时的中位年龄为37岁（范围21至44岁）。我们回顾性评估了所有患者的病理检查结果、所施行的手术及结果。平均随访时间为55.7个月。
5例患者仅进行了胸膜固定术，5例患者同时进行了相关的膈肌手术。5例患者未发现膈肌异常：其中3例经历了一次或多次复发，且均仍患有慢性月经性胸痛。激素治疗使2例患者的病情在6个月内得到了暂时改善。相反，在5例患者中，手术胸膜固定术联合膈肌缺损修复（单纯缝合或用聚乙醇酸网片覆盖）：这些患者无复发（n = 0/5，p = 0.0016），且随后也没有月经性胸痛。
术后结果受有无子宫内膜异位症的膈肌缺损诊断的影响。手术治疗应在月经期间进行，以便最佳地观察胸膜膈肌子宫内膜异位症。由于膈肌病变很常见且可能隐匿，我们建议即使膈肌外观正常，也系统性地用聚乙醇酸网片覆盖膈肌表面，以防止月经性气胸复发。
