Bobbio Antonio, Ampollini Luca, Internullo Eveline, Caporale Domenico, Cattelani Leonardo, Bettati Stefano, Carbognani Paolo, Rusca Michele
Division of Thoracic Surgery, Department of Surgical Sciences, University of Parma, Viale Gramsci 14, 43100 Parma, Italy.
Eur J Cardiothorac Surg. 2006 Jan;29(1):6-8. doi: 10.1016/j.ejcts.2005.10.034. Epub 2005 Dec 6.
The obliteration of pleural space is useful to prevent recurrences of spontaneous pneumothorax. We retrospectively compared the results of pleural argon beam coagulation versus pleural abrasion in the treatment of primary spontaneous pneumothorax.
Between 1996 and 2004, 136 patients underwent surgery for primary spontaneous pneumothorax, with 143 surgical procedures, all performed by VATS. Indications were recurrent pneumothorax in 107 patients, a complicated first episode in 29 and occupational activity in 7. Six patients were excluded because of postoperative histopathological diagnosis other than pulmonary emphysema. In 70 cases pleurodesis was performed with argon beam coagulation and in 67 by Marlex degrees mesh abrasion. These techniques were employed during two different periods. Median follow-up was 68 months in the Marlex degrees group and 41 in the argon group. The two groups resulted as being homogeneous for gender, age, smoking attitude and surgical indication. Statistical analysis was done with chi2 and Fisher's test.
No postoperative mortality was observed. Mean recovery time was 5 days. There were three patients with postoperative bleeding who underwent re-operation. There were nine cases of prolonged air-leak, one needing surgical exploration. Nine recurrences were noted, all requiring surgery. Two recurrences were observed in the group treated by pleural abrasion (3.4%) and seven in the group treated by argon coagulation (10.7%). The Fisher's test failed to demonstrate a statistical significance between the two procedures in terms of recurrence rate (p=0.18). Multivariate analysis yielded no risk factors for recurrences. Postoperative complications resulted as being equally distributed in both groups.
After primary spontaneous pneumothorax, pleurodesis induced by argon beam parietal pleural coagulation resulted as being no better than that obtained by pleural abrasion in the prevention of recurrences. No benefits in terms of postoperative complications resulted by use argon beam coagulation.
使胸膜腔闭塞有助于预防自发性气胸复发。我们回顾性比较了氩气刀胸膜凝固术与胸膜摩擦术治疗原发性自发性气胸的效果。
1996年至2004年间，136例患者因原发性自发性气胸接受手术，共进行了143例手术，均通过电视辅助胸腔镜手术（VATS）完成。适应证包括107例复发性气胸、29例首次发作且病情复杂以及7例因职业活动需求。6例患者因术后组织病理学诊断并非肺气肿而被排除。70例采用氩气刀进行胸膜固定术，67例采用Marlex网片摩擦术。这两种技术在两个不同时期应用。Marlex网片组的中位随访时间为68个月，氩气组为41个月。两组在性别、年龄、吸烟情况和手术适应证方面具有同质性。采用卡方检验和费舍尔检验进行统计学分析。
未观察到术后死亡病例。平均恢复时间为5天。有3例患者术后出血，接受了再次手术。有9例出现持续性漏气，其中1例需要手术探查。观察到9例复发，均需再次手术。胸膜摩擦术治疗组有2例复发（3.4%），氩气凝固术治疗组有7例复发（10.7%）。费舍尔检验未显示两种手术在复发率方面具有统计学差异（p = 0.18）。多因素分析未得出复发的危险因素。术后并发症在两组中分布相同。
原发性自发性气胸后，氩气刀壁层胸膜凝固术诱导的胸膜固定术在预防复发方面并不优于胸膜摩擦术。使用氩气刀凝固术在术后并发症方面并无益处。
