Ciriaco Paola, Negri Giampiero, Libretti Lidia, Carretta Angelo, Melloni Giulio, Casiraghi Monica, Bandiera Alessandro, Zannini Piero
Department of Thoracic Surgery, Scientific Institute and University Vita-Salute H San Raffaele, Milan, Italy.
Interact Cardiovasc Thorac Surg. 2009 Mar;8(3):349-52. doi: 10.1510/icvts.2008.190975. Epub 2008 Dec 16.
We retrospectively reviewed our experience with catamenial pneumothorax (CP) in terms of treatment and follow-up. From 1993 to 2008, ten women presented at our department with CP. CP was right-sided in all patients: seven presented diaphragmatic defects including one endometriosis, five had apical bulla or blebs that in three patients were the only pathological findings. Surgical approach was thoracoscopic with a muscle-sparing thoracotomy when diaphragmatic defects where present. All patients underwent apical resection and apical pleurectomy associated in seven cases with diaphragmatic plication and chemical pleurodesis. After surgery nine patients underwent hormonal treatment: three were put on estrogen-progesterone complex treatment and six received gonadotropin-releasing hormone agonist (GnRH agonist). Recurrence rate was 40% and it was significantly correlated with estrogen-progesterone treatment (P<0.005). The mean follow-up was 52+/-32 months (range 14-168). At the present time, no recurrence has occurred in all women. Occurrence of CP is often underestimated. At the time of surgery the diaphragm should be carefully inspected for defects and/or endometriosis. Standard pleurodesis may not suffice and we suggest apical resection and apical pleurectomy associated with a diaphragmatic procedure when indicated. Hormonal treatment with GnRH agonist seems to improve the outcome.
我们回顾性地分析了我们在月经性气胸（CP）治疗及随访方面的经验。1993年至2008年期间，有10名女性因CP前来我科就诊。所有患者的气胸均发生在右侧：7例存在膈肌缺损，其中1例合并子宫内膜异位症；5例有肺尖大疱或肺小疱，其中3例这些是唯一的病理表现。当存在膈肌缺损时，手术方式为胸腔镜手术并辅以保留肌肉的开胸手术。所有患者均接受了肺尖切除术和肺尖胸膜切除术，7例同时进行了膈肌折叠术和化学胸膜固定术。术后9例患者接受了激素治疗：3例接受雌激素 - 孕激素联合治疗，6例接受促性腺激素释放激素激动剂（GnRH激动剂）治疗。复发率为40%，且与雌激素 - 孕激素治疗显著相关（P<0.005）。平均随访时间为52±32个月（范围14 - 168个月）。目前，所有女性均未复发。CP的发生率常被低估。手术时应仔细检查膈肌是否存在缺损和/或子宫内膜异位症。标准的胸膜固定术可能不够，我们建议在有指征时，行肺尖切除术和肺尖胸膜切除术并联合膈肌手术。GnRH激动剂激素治疗似乎可改善治疗效果。
