Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7 Chung Shan South Road, Taipei, Taiwan.
Surg Endosc. 2009 Nov;23(11):2438-44. doi: 10.1007/s00464-009-0404-8. Epub 2009 Mar 5.
Video-assisted thoracoscopic surgery (VATS) is the popular method for treating primary spontaneous pneumothorax (PSP). Nevertheless, the optimal management of pneumothorax recurrence after VATS remains unclear. This study evaluated the efficacies of various treatment methods.
Between 1992 and 2008, 53 cases of recurrent ipsilateral pneumothoraces were noted after 978 VATS treatments for PSP. The primary treatments included 19 observations, 14 pleural drainages with and without sclerosis, 19 redo VATS, and one thoracotomy. The demographic data and treatment outcomes were collected through retrospective chart reviews.
The mean interval between VATS and the first recurrence was 12.8 months. Patients who underwent observation had smaller recurrences than those who underwent pleural drainage or redo VATS. The primary failure rate was 5% (1/19) for observation, 50% (7/14) for pleural drainage, 0% (0/19) for redo VATS, and 0% (0/1) for thoracotomy. After a mean follow-up period of 36 months, the repeat recurrence rate was 63.1% (12/19) for observation, 7.1% (1/14) for pleural drainage, 0% (0/19) for redo VATS, and 0% (0/1) for thoracotomy. The mean total hospital stay was 2.5 days for observation, 8.1 days for pleural drainage, 6.6 days for redo VATS, and 15 days for thoracotomy. Finally, redo VATS was performed as the primary or salvage treatment for 34 patients. Neither conversion to thoracotomy nor blood transfusion was required for any patient. Only one patient had a repeat recurrence (2.9%, 1/34).
Redo VATS is a feasible and less invasive alternative to thoracotomy for treating recurrent pneumothorax after VATS. In contrast, both observation and pleural drainage have high treatment failures rates and thus are not recommended.
电视辅助胸腔镜手术（VATS）是治疗原发性自发性气胸（PSP）的常用方法。然而，VATS 后气胸复发的最佳治疗方法仍不清楚。本研究评估了各种治疗方法的疗效。
1992 年至 2008 年间，978 例 VATS 治疗 PSP 后出现 53 例同侧复发性气胸。主要治疗方法包括 19 例观察、14 例胸腔引流加或不加硬化剂、19 例再次 VATS 和 1 例开胸手术。通过回顾性病历回顾收集人口统计学数据和治疗结果。
VATS 与第一次复发之间的平均间隔为 12.8 个月。观察组患者的复发程度小于胸腔引流或再次 VATS 组。观察组的主要失败率为 5%（1/19），胸腔引流组为 50%（7/14），再次 VATS 组为 0%（0/19），开胸手术组为 0%（0/1）。平均随访 36 个月后，观察组的再次复发率为 63.1%（12/19），胸腔引流组为 7.1%（1/14），再次 VATS 组为 0%（0/19），开胸手术组为 0%（0/1）。观察组的平均总住院时间为 2.5 天，胸腔引流组为 8.1 天，再次 VATS 组为 6.6 天，开胸手术组为 15 天。最后，34 例患者再次行 VATS 作为主要或挽救性治疗。没有患者需要转为开胸手术或输血。只有 1 例患者再次复发（2.9%，1/34）。
对于 VATS 后复发性气胸，再次 VATS 是开胸手术的一种可行且微创的替代方法。相比之下，观察和胸腔引流的治疗失败率都很高，因此不推荐使用。
