Lee Pyng, Yap Wee See, Pek Wee Yang, Ng Alan Wei Keong
Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.
Chest. 2004 Apr;125(4):1315-20. doi: 10.1378/chest.125.4.1315.
To prospectively study all patients with COPD and spontaneous pneumothorax (SP) who underwent thoracoscopic talc poudrage (TP) under local anesthesia to determine its efficacy and safety in recurrence prevention.
Data on clinical measurements, complications, duration of chest tube drainage, length of hospital stay, and outcome were collected.
Forty-one patients (38 men and 3 women) with a mean (+/- SD) age of 70.7 +/- 7.2 years were treated. All patients had COPD, with a mean FEV(1) of 41 +/- 14% predicted. The majority of SPs measured 20 to 50% in size, and 34% were recurrent. Three grams of talc were insufflated into the pleural cavity without complications. Thirteen patients (32%) complained of pain, 5 (12%) developed fever, 27 (66%) had subcutaneous emphysema, and 7 (17%) had prolonged air leaks. Postoperative chest tube drainage and hospital stay were 4 and 5 days, respectively. Success was 95% after a median follow-up of 35 months. Four patients with FEV(1) of < 40% predicted died within 30 days of the procedure, yielding a mortality rate of 10%. FEV(1) (in liters), FEV(1) (in % predicted), and ischemic heart disease were risk factors that influenced early mortality.
Thoracoscopic TP is effective for pneumothorax prevention and can be performed with acceptable mortality in patients with advanced COPD.
前瞻性研究所有接受局部麻醉下胸腔镜滑石粉喷洒术（TP）的慢性阻塞性肺疾病（COPD）合并自发性气胸（SP）患者，以确定其预防复发的有效性和安全性。
收集临床测量、并发症、胸腔闭式引流持续时间、住院时间及结果的数据。
治疗了41例患者（38例男性和3例女性），平均（±标准差）年龄为70.7±7.2岁。所有患者均患有COPD，预计第一秒用力呼气容积（FEV₁）平均为41±14%。大多数SP大小为20%至50%，34%为复发性。向胸腔内注入3克滑石粉，无并发症发生。13例患者（32%）诉疼痛，5例（12%）发热，27例（66%）有皮下气肿，7例（17%）有持续性漏气。术后胸腔闭式引流和住院时间分别为4天和5天。中位随访35个月后成功率为95%。4例预计FEV₁<40%的患者在术后30天内死亡，死亡率为10%。FEV₁（升）、FEV₁（预计值百分比）和缺血性心脏病是影响早期死亡率的危险因素。
胸腔镜TP对预防气胸有效，在晚期COPD患者中进行该手术的死亡率可接受。
