Noppen Marc, Stratakos Grigoris, Verbanck Sylvia, D'Haese Jan, Meysman Marc, Vincken Walter
Interventional Endoscopy Clinic, Anaesthesiology Department and Respiratory Division, University Hospital AZ VUB, Brussels, Belgium.
Am J Respir Crit Care Med. 2004 Sep 15;170(6):680-2. doi: 10.1164/rccm.200404-438CR. Epub 2004 Jun 23.
The exact site of air leakage in a patient with primary spontaneous pneumothorax is difficult to determine and locate. In particular, the role of rupture of emphysema-like changes (blebs and bullae) versus that of enhanced porosity of lung parenchyma in the pathophysiology of primary spontaneous pneumothorax remains unclear. This is the first description of a patient with recurrent primary spontaneous pneumothorax in whom inhalation of aerosolized fluorescein followed by autofluorescence thoracoscopy allowed in vivo localization of various lung areas of extensive subpleural fluorescein accumulation which were not, or only partly, visibly abnormal during normal white light thoracoscopy. No air leak was present at the time of thoracoscopy. No emphysema-like changes were seen. Our findings suggest substantial areas of parenchymal abnormality that remain unnoticed by white light thoracoscopic inspection of the parenchymal surface. In this respect, fluorescein-enhanced autofluorescence thoracoscopy may become an exciting tool in the study of the pathophysiology of primary spontaneous pneumothorax, and could prove useful in clinical practice in determining the sites of surgical staple resection whenever this treatment modality is considered.
原发性自发性气胸患者漏气的确切部位很难确定和定位。特别是，在原发性自发性气胸的病理生理学中，类肺气肿样改变（肺大疱和肺气囊）破裂与肺实质孔隙率增加所起的作用仍不明确。本文首次描述了一名复发性原发性自发性气胸患者，通过吸入雾化荧光素后进行自体荧光胸腔镜检查，在体内定位了广泛的胸膜下荧光素积聚的各个肺区域，这些区域在正常白光胸腔镜检查时未出现明显异常或仅部分可见异常。胸腔镜检查时未发现漏气现象，也未观察到类肺气肿样改变。我们的研究结果表明，在白光胸腔镜检查肺实质表面时，存在大量未被注意到的实质异常区域。在这方面，荧光素增强自体荧光胸腔镜检查可能成为研究原发性自发性气胸病理生理学的一个令人兴奋的工具，并且在考虑采用手术吻合器切除治疗方式时，可能在临床实践中有助于确定手术切除部位。
