Alifano Marco, Jablonski Christine, Kadiri Habiba, Falcoz Pierre, Gompel Anne, Camilleri-Broet Sophie, Regnard Jean-François
Department of Thoracic Surgery, Hôtel-Dieu Hospital, Paris V University, Paris, France.
Am J Respir Crit Care Med. 2007 Nov 15;176(10):1048-53. doi: 10.1164/rccm.200704-587OC. Epub 2007 Jul 12.
Catamenial and endometriosis-related pneumothorax are considered relatively rare entities. Their clinical characteristics and outcome are incompletely known.
To evaluate the frequencies, clinical characteristics, and outcomes of catamenial and endometriosis-related pneumothoraces occurring in women with no underlying lung disease referred for surgical treatment.
Clinical files of all the women of reproductive age referred to our center during a 6-year period for surgical treatment of spontaneous pneumothorax were retrospectively reviewed. Catamenial pneumothorax (CP) was defined as recurrent pneumothorax occurring between the day before and within 72 hours after the onset of menses. All histologic slides were reviewed to confirm initial diagnoses.
A total of 114 women underwent video-assisted thoracic surgery; 28 women (24.6%) had CP (right-sided in all but one), and diaphragmatic abnormalities (perforations and/or nodules) were observed in 22 of them. Diaphragmatic abnormalities were seen in 21 of 86 patients with non-CP. Histologic examination found endometriosis, mainly diaphragmatic, in 18 of 28 CPs and 11 of 86 non-CPs. A 6-month antigonadotropic treatment was prescribed postoperatively to women with either CP or endometriosis-related pneumothorax. Mean follow-up was 32.7 (+/-18.5) months. Recurrence rates in CP, non-CP but endometriosis-related, and non-CP non-endometriosis-related pneumothoraces were 32, 27, and 5.3%, respectively.
Our experience shows that (1) CP and/or endometriosis-related pneumothoraces account for an important percentage of spontaneous pneumothoraces referred for surgery, (2) diaphragmatic abnormalities seem to play a fundamental role in their pathogenesis, and (3) management is difficult because of the high recurrence rate.
月经性气胸和子宫内膜异位症相关气胸被认为是相对罕见的病症。它们的临床特征和预后尚不完全清楚。
评估因手术治疗而转诊的无基础肺部疾病女性中月经性气胸和子宫内膜异位症相关气胸的发生率、临床特征及预后。
回顾性分析6年间转诊至本中心接受自发性气胸手术治疗的所有育龄期女性的临床资料。月经性气胸（CP）定义为月经开始前一天至月经开始后72小时内发生的复发性气胸。复查所有组织学切片以确认初始诊断。
共有114名女性接受了电视辅助胸腔镜手术；28名女性（24.6%）患有CP（除1例为左侧外均为右侧），其中22例观察到膈肌异常（穿孔和/或结节）。86例非CP患者中有21例出现膈肌异常。组织学检查发现，28例CP患者中有18例、86例非CP患者中有11例存在子宫内膜异位症，主要位于膈肌。对患有CP或子宫内膜异位症相关气胸的女性术后给予6个月的促性腺激素释放激素激动剂治疗。平均随访时间为32.7（±18.5）个月。CP组、非CP但与子宫内膜异位症相关组以及非CP非子宫内膜异位症相关组的气胸复发率分别为32%、27%和5.3%。
我们的经验表明，（1）CP和/或子宫内膜异位症相关气胸在因手术转诊的自发性气胸中占重要比例；（2）膈肌异常似乎在其发病机制中起重要作用；（3）由于复发率高，治疗困难。
