Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
Ann Thorac Surg. 2010 Mar;89(3):891-7; discussion 897-8. doi: 10.1016/j.athoracsur.2009.12.012.
Persistent air leak (PAL; defined as air leak > 5 days) after major pulmonary resection is prevalent and associated with significant morbidity. This study examines an incompletely characterized treatment for the management of PAL, chemical pleurodesis.
A retrospective case-control study examining all isolated lobectomies and bilobectomies by thoracotomy was performed. The PALs (1997 to 2006) and controls (2002 to 2006) were identified from a prospective database. Incidence, risk factors, management, and outcome were defined.
Over 9 years, 78 PALs were identified in 1,393 patients (5.6%). Controls consisted of 700 consecutive patients. Propensity score analysis matching case and controls showed no predictive risk factors for air leak using a logistic regression model. Univariate analysis demonstrated that female gender, smoking history, and forced vital capacity were predictive risk factors. Treatment of PAL consisted of observation (n = 33, 42.3%), pleurodesis (n = 41, 52.6%), Heimlich valve (n = 3, 3.8%), and reoperation (n = 1, 1.3%). Seventy-three patients (93.6%) required no further intervention. One patient required a muscle flap, one readmission for pneumothorax, and one empyema resulting in death. Sclerosis was successful in 40 of 41 patients (97.6%). Mean time to treatment was 8.4 +/- 3.6 days, mean duration of air leak was 10.7 +/- 4.5, and mean duration of air leak postsclerotherapy was 2.8 +/- 2.2 days. Postoperative pneumonia occurred with increased frequency in PAL patients (6 of 45 [13.3%] vs 34 of 700 [4.9%], p = 0.014). PAL was associated with increased length of stay (14.2 vs 7.1 days, p < 0.001) and time with chest tube (11.5 vs 3.4 days, p < 0.001).
Air leaks remain an important cause of morbidity. Pleurodesis is an effective option in management of PAL after major pulmonary resection.
肺切除术后持续性肺漏气（PAL；定义为漏气 > 5 天）很常见，且与显著发病率相关。本研究分析了一种不完全特征的治疗方法，即化学性胸膜固定术，用于治疗 PAL。
对所有经胸切开术行孤立性肺叶切除术和双肺叶切除术进行回顾性病例对照研究。PAL 组（1997 年至 2006 年）和对照组（2002 年至 2006 年）从前瞻性数据库中确定。定义了发病率、危险因素、处理和结果。
在 9 年期间，在 1393 例患者中发现了 78 例 PAL（5.6%）。对照组包括 700 例连续患者。采用逻辑回归模型进行的倾向评分分析匹配病例和对照组，结果显示没有预测性的漏气危险因素。单因素分析表明，女性性别、吸烟史和用力肺活量是预测性危险因素。PAL 的治疗包括观察（n = 33，42.3%）、胸膜固定术（n = 41，52.6%）、Heimlich 阀（n = 3，3.8%）和再次手术（n = 1，1.3%）。73 例（93.6%）患者无需进一步干预。1 例患者需要肌肉瓣，1 例患者因气胸再次入院，1 例患者因脓胸导致死亡。硬化剂治疗在 41 例患者中的 40 例（97.6%）中取得成功。治疗的平均时间为 8.4 ± 3.6 天，平均漏气时间为 10.7 ± 4.5 天，硬化治疗后平均漏气时间为 2.8 ± 2.2 天。PAL 患者术后肺炎的发生率更高（6 例PAL 患者中有 45 例[13.3%] vs 700 例对照组中有 34 例[4.9%]，p = 0.014）。PAL 与住院时间延长（14.2 天 vs 7.1 天，p < 0.001）和带胸管时间延长（11.5 天 vs 3.4 天，p < 0.001）相关。
漏气仍然是发病率的一个重要原因。胸膜固定术是肺切除术后治疗 PAL 的有效方法。
