Department of General Thoracic Surgery, Iizuka Hospital, 3-83 Yoshio, Iizuka, Fukuoka, 820-8505, Japan.
Surg Endosc. 2009 Nov;23(11):2515-21. doi: 10.1007/s00464-009-0436-0. Epub 2009 Mar 19.
The outcome of thoracoscopic bullectomy for primary spontaneous pneumothorax (PSP) is not satisfactory. To reduce postoperative pneumothorax recurrence after thoracoscopic bullectomy, an effective and easy surgical method is required. We tried a new method using an absorbable mesh that covered the whole apical visceral pleura.
A total of 157 sides of 143 patients who underwent stapled bullectomy under thoracoscopy for PSP were reviewed retrospectively. In the apical covering group (group A), a 15 x 15-cm(2) absorbable mesh sheet was placed on the apical visceral pleura with fibrin glue. Patients in group B underwent bullectomy alone. Cumulative postoperative recurrence was compared between the groups. Recurrent cases in group A were examined clinicopathologically.
Group A had 111 cases and group B had 46. There was no operative mortality. Postoperative recurrence occurred in 15 of 157 cases (9.6%): 4 in group A and 11 in group B. The cumulative postoperative 5-year recurrence rate was 3.6% in group A and 23.9% in group B (log-rank test, p = 0.013). In group A, local adhesion was seen at the apical pleurae, and inflammatory changes with foreign body giant cells were seen at the pleura covered with the mesh.
Placement of a wide absorbable mesh with fibrin glue at the apical visceral pleura significantly reduced postoperative recurrence after thoracoscopic bullectomy for PSP. The mesh was thought to act as a foreign body on the pleura and induce local inflammatory adhesion between the apical pleurae after bullectomy. This was an easy and effective symphysial procedure.
胸腔镜肺大疱切除术治疗原发性自发性气胸（PSP）的效果并不理想。为了降低胸腔镜肺大疱切除术后气胸复发的风险，需要一种有效的、简单的手术方法。我们尝试了一种新的方法，使用一种可吸收的网片覆盖整个肺尖脏层胸膜。
回顾性分析了 143 例患者的 157 侧因 PSP 行胸腔镜下单发肺大疱切除术的病例，其中使用纤维蛋白胶将 15x15cm²可吸收网片覆盖于肺尖脏层胸膜的患者归入 A 组（n=111），仅行肺大疱切除术的患者归入 B 组（n=46）。比较两组患者的术后累积复发率。对 A 组中复发的患者进行临床病理检查。
A 组 111 例，B 组 46 例。无手术死亡病例。术后复发 15 例（9.6%）：A 组 4 例，B 组 11 例。A 组术后 5 年累积复发率为 3.6%，B 组为 23.9%（log-rank 检验，p=0.013）。A 组肺尖部可见局部粘连，网片覆盖的胸膜可见异物巨细胞引起的炎症改变。
在肺尖脏层胸膜使用可吸收网片联合纤维蛋白胶可显著降低胸腔镜肺大疱切除术后 PSP 的复发率。网片在胸膜上被认为是一种异物，可在肺大疱切除术后引起肺尖部之间的局部炎症粘连。这是一种简单而有效的联合手术方法。
