Sawada Shigeki, Watanabe Yoichi, Moriyama Shigeharu
Department of Surgery, Okayama Red Cross General Hospital, Japan.
Chest. 2005 Jun;127(6):2226-30. doi: 10.1378/chest.127.6.2226.
Video-assisted thoracoscopic surgery (VATS) is effective for primary spontaneous pneumothorax. We sought to evaluate the outcome of VATS compared to conservative treatment and open thoracotomy, and to discuss the indications for VATS in primary spontaneous pneumothorax.
Retrospective study.
Primary spontaneous pneumothorax was diagnosed in 281 consecutive patients between January 1989 and April 2001. Mean age was 29.1 years. Mean follow-up period was 78.3 months (range, 13 to 163 months). For these patients, conservative treatment, open thoracotomy, or VATS were performed, and the outcomes of the three treatments were evaluated. If recurrence occurred, outcome of treatment for the recurrence was also evaluated according to the number of times of recurrence.
Recurrences were observed in 109 of 281 patients (38.8%). Forty-three patients (15.3%) had repeat recurrences. Regarding the outcome of the first episode, recurrence rates were 54.7% for conservative treatment, 7.7% for open thoracotomy, and 10.3% for VATS. Recurrence rates after the second episode were 60.3% for conservative treatment, 0% for open thoracotomy, and 18.6% for VATS. Overall recurrence rates of each treatment were 56.4%, 3.0%, and 11.7%, respectively. There was no statistical difference between the open thoracotomy and VATS groups (p = 0.15). Hospital stays from operation until discharge were 11.5 days for open thoracotomy and 4.1 days for VATS (p < 0.001).
The outcomes of VATS were very good compared to conservative treatment and equal to those of the open thoracotomy, not only for the first episode but also for the case of recurrence. In terms of low morbidity, low invasiveness, and cosmetic issues, VATS is superior to open thoracotomy. VATS is standard in cases of recurrence and should be considered for treatment at the first episode.
电视辅助胸腔镜手术（VATS）治疗原发性自发性气胸疗效显著。我们旨在评估VATS与保守治疗及开胸手术相比的治疗效果，并探讨VATS在原发性自发性气胸治疗中的适应证。
回顾性研究。
1989年1月至2001年4月期间连续诊断出281例原发性自发性气胸患者。平均年龄29.1岁。平均随访期78.3个月（范围13至163个月）。对这些患者分别进行保守治疗、开胸手术或VATS，并评估三种治疗方法的效果。若出现复发，还根据复发次数评估复发治疗的效果。
281例患者中有109例（38.8%）出现复发。43例患者（15.3%）有多次复发。就首次发作的治疗效果而言，保守治疗的复发率为54.7%，开胸手术为7.7%，VATS为10.3%。第二次发作后，保守治疗的复发率为60.3%，开胸手术为0%，VATS为18.6%。每种治疗方法的总体复发率分别为56.4%、3.0%和11.7%。开胸手术组与VATS组之间无统计学差异（p = 0.15）。开胸手术从手术到出院的住院时间为11.5天，VATS为4.1天（p < 0.001）。
与保守治疗相比，VATS的治疗效果非常好，且与开胸手术相当，无论是首次发作还是复发情况。在低发病率、低侵袭性和美观问题方面，VATS优于开胸手术。VATS是复发病例的标准治疗方法，首次发作时也应考虑采用。
