Department of Thoracic and Cardiovascular Surgery, Aristotle University Medical School, AHEPA University Hospital, Stilponos Kiriakidi Street, 54636, Thessaloniki, Greece.
Surg Endosc. 2012 Mar;26(3):607-14. doi: 10.1007/s00464-011-1734-x. Epub 2011 May 12.
Currently, most thoracic surgeons perform surgical pleurodesis for recurrent spontaneous pneumothorax (RSP) by video-assisted thoracic surgery (VATS). However, the superiority of VATS over axillary minithoracotomy is not been established in prospective studies to date. A modified two-port VATS technique and axillary minithoracotomy were prospectively evaluated for possible differences in the short- and long-term outcome for patients.
In this study, 66 consecutive patients underwent surgical pleurodesis for RSP through either a modified two-port VATS procedure (group A, 33 patients) or axillary minithoracotomy (group B, 33 patients). According to the study design (NCT01192217), the patients were randomly assigned to the two groups, which were similar in terms of age and body mass index. One-lung ventilation time, histology of the available lung parenchyma specimens, early postoperative complications, length of chest tube drainage and hospital stay, recurrence rate, and a score for patient satisfaction with treatment based on the sum of postoperative pain, dependent-arm mobilization, and return to full activity subscores were evaluated. The follow-up period varied from 3 to 53 months (median, 30 months).
The one-lung ventilation and operating times were significantly longer (p < 0.001) in group A than in group B. The overall detection of blebs, bulla, or both was 51.5% in group A and 63.8% in group B. The recurrence rate, complication rate, postoperative chest tube drainage duration, postoperative hospital stay, and incidence of chronic pain did not differ between the two groups. The score for patient satisfaction with treatment was significantly higher in group A than in group B (p < 0.001) according the subscores for better dependent-arm mobilization and return to full activity.
Axillary minithoracotomy and VATS are equally effective for the treatment of RSP, although the rate for resection of blebs, bulla, or both is higher with the axillary minithoracotomy procedure. Although VATS is more time consuming, it offers to the patient more satisfaction with treatment.
目前，大多数胸外科医生通过电视辅助胸腔镜手术（VATS）对复发性自发性气胸（RSP）进行手术胸膜固定术。然而，迄今为止，前瞻性研究并未确定 VATS 优于腋窝小开胸术。本研究前瞻性评估了改良双端口 VATS 技术和腋窝小开胸术在患者短期和长期结局方面的可能差异。
本研究中，66 例连续患者因 RSP 接受手术胸膜固定术，分别通过改良双端口 VATS 手术（A 组，33 例）或腋窝小开胸术（B 组，33 例）。根据研究设计（NCT01192217），患者被随机分配到两组，两组在年龄和体重指数方面相似。评估单肺通气时间、可用肺实质标本的组织学、早期术后并发症、胸腔引流管引流和住院时间、复发率以及基于术后疼痛、依赖臂活动度和恢复全活动度等子评分总和的患者对治疗满意度评分。随访时间为 3 至 53 个月（中位数，30 个月）。
A 组的单肺通气时间和手术时间明显长于 B 组（p<0.001）。A 组发现疱、大疱或两者的总检出率为 51.5%，B 组为 63.8%。两组间复发率、并发症发生率、术后胸腔引流时间、术后住院时间和慢性疼痛发生率无差异。根据依赖臂活动度和恢复全活动度的子评分，A 组患者对治疗的满意度评分明显高于 B 组（p<0.001）。
腋窝小开胸术和 VATS 治疗 RSP 的效果相当，尽管腋窝小开胸术切除疱、大疱或两者的比率更高。虽然 VATS 时间较长，但患者对治疗的满意度更高。
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