Noda M, Oishi H, Maeda S, Sado T, Sakurada A, Hoshikawa Y, Endo C, Okada Y, Kondo T
Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan.
Kyobu Geka. 2011 Apr;64(4):291-5.
Secondary spontaneous pneumothorax (SSP) such as lymphangioleiomyomatosis (LAM), bronchiolitis obliterans (BO) is intractable or repeated the recurrence of pneumothorax. The most effective chemical pleurodesis for intractable pneumothorax is talc poudrage and so on that is associated with a reduction in the rate of pneumothorax recurrence. However, severe and broad pleural adhesion due to the pleural interventional procedures sometimes cause serious bleeding when the patients undergo lung transplantation. We must be considered for new approaches to these intractable secondary pneumothoraces which replaced traditional conservative and surgical approaches. We had proposed new 2 approaches of total pleural covering (TPC) and awake surgical intervention (ASI) for intractable pneumothorax. We applied the TPC modified with coverage of air leak points with polyglycolic acid (PGA) sheet to 5 patients with intractable bilateral pneumothorax to reduce the risk of excessive bleeding by chemical pleurodesis in lung transplantation. The bilateral pneumothorax was well controlled, and no recurrence has been observed. TPC is reliable procedure for management intractable bilateral SSP. For 12 high-risk patients with other underling pulmonary diseases on general poor conditions, a surgical intervention was performed in awake condition. The air leaks were stopped in 11 cases except for 1 case. The recurrence of pneumothorax after surgery was 2 cases. ASI for intractable secondary pneumothorax can be applicable to selected patients with deteriorated general condition.
继发性自发性气胸（SSP），如淋巴管平滑肌瘤病（LAM）、闭塞性细支气管炎（BO），气胸难以治疗或反复复发。对于难治性气胸，最有效的化学性胸膜固定术是滑石粉喷洒等，这与气胸复发率的降低有关。然而，由于胸膜介入操作导致的严重广泛的胸膜粘连，有时会在患者接受肺移植时引起严重出血。我们必须考虑针对这些难治性继发性气胸的新方法，以取代传统的保守和手术方法。我们提出了两种新的方法，即全胸膜覆盖（TPC）和清醒手术干预（ASI）来治疗难治性气胸。我们将用聚乙醇酸（PGA）片覆盖漏气点改良后的TPC应用于5例难治性双侧气胸患者，以降低肺移植时化学性胸膜固定术导致过度出血的风险。双侧气胸得到了很好的控制，且未观察到复发。TPC是治疗难治性双侧SSP的可靠方法。对于12例合并其他基础肺部疾病、全身状况较差的高危患者，在清醒状态下进行了手术干预。除1例患者外，11例患者的漏气停止。术后气胸复发2例。ASI治疗难治性继发性气胸可应用于全身状况恶化的特定患者。
