The University of Tokyo Graduate School of Medicine, Japan.
Curr Opin Pulm Med. 2010 Jul;16(4):376-80. doi: 10.1097/MCP.0b013e32833a3d96.
Secondary spontaneous pneumothorax (SSP) can occur in patients who are suffering from diffuse lung disease. The main cause of SSP is chronic obstructive pulmonary disease (COPD). In contrast to primary spontaneous pneumothorax, SSP is a potentially life-threatening condition because patients with SSP also have limited cardiopulmonary reserve. Prompt diagnosis and treatment of SSP are mandatory. In this review, thoracoscopy, a less invasive surgical treatment for SSP, is discussed from the viewpoint of postoperative morbidity, mortality, and recurrence of SSP.
A meta-analysis showed that postoperative recurrence of pneumothorax is more frequently observed following thoracoscopy than following open thoracotomy. Recent studies on thoracoscopic surgery for SSP have shown that the rate of postoperative morbidity is still high (15-27.7%) and thoracoscopy is sometimes replaced with open thoracotomy because of dense pleural adhesion or inability to maintain one-lung ventilation during surgery. However, many thoracic surgeons prefer to perform thoracoscopic surgery for SSP because it is less invasive than open thoracotomy. Techniques for bullectomy and pleurodesis are currently being adapted to decrease the recurrence rate of pneumothorax.
Thoracoscopic surgery for the treatment of SSP should be less invasive to reduce postoperative morbidity, and it should also be more effective to reduce the recurrence of pneumothorax.
继发自发性气胸（SSP）可发生于患有弥漫性肺部疾病的患者中。SSP 的主要病因是慢性阻塞性肺疾病（COPD）。与原发性自发性气胸不同，SSP 是一种潜在的危及生命的病症，因为 SSP 患者的心肺储备也有限。因此，SSP 的及时诊断和治疗是强制性的。在本次综述中，从术后发病率、死亡率和 SSP 复发的角度探讨了对 SSP 具有侵袭性较小的手术治疗——电视胸腔镜手术。
一项荟萃分析表明，电视胸腔镜手术后气胸复发的发生率高于开胸手术。最近关于 SSP 电视胸腔镜手术的研究表明，术后发病率仍然很高（15-27.7%），并且由于胸膜致密粘连或手术期间无法维持单肺通气，有时会将电视胸腔镜手术替换为开胸手术。然而，许多胸外科医生更喜欢对 SSP 进行电视胸腔镜手术，因为它比开胸手术具有更小的侵袭性。目前正在调整肺大疱切除术和胸膜固定术的技术，以降低气胸复发率。
治疗 SSP 的电视胸腔镜手术应减少术后发病率，并且更有效地降低气胸复发率。
