Lin C T, Chen C Y, Chen C L, Hsu N Y, Wang P Y
Department of Surgery, Veterans General Hospital-Taichung, Taiwan, R.O.C.
Zhonghua Yi Xue Za Zhi (Taipei). 1990 Aug;46(2):91-5.
From 1982 to 1989, 293 patients with spontaneous pneumothorax were treated at VGHTC. There were 251 males and 42 females, aged 1-85 years, mean 49.3 years. The location of pneumothorax included right side 148 cases, left side 129 cases and bilateral 16 cases. The treatment included tube thoracostomy in 282 cases, thoracotomy abrasive pleurodesis in 39 cases, median sternotomy bilateral abrasive pleurodesis in 31 cases and chemical pleurodesis in 18 cases. Indications for pleurodesis included (1) recurrent pneumothorax (2) bilateral pneumothorax (3) persistent air leakage more than 7 days (4) massive air leakage (5) complications of pneumothorax. From our study, we concluded that: (1) The simplest management for spontaneous pneumothorax is tube thoracostomy. (2) In young adults or suspicious bilateral lesions, median sternotomy with bilateral abrasive pleurodesis is first choice of management for some special indications. (3) In aged patients or patients needing concomitant procedure for other pulmonary disease, thoracotomy abrasive pleurodesis is better choice. (4) When poor lung function and contraindicated to have an operation, chemical pleurodesis can also get some advantages.
1982年至1989年期间，弗吉尼亚梅森医疗中心（VGHTC）共收治了293例自发性气胸患者。其中男性251例，女性42例，年龄在1至85岁之间，平均年龄49.3岁。气胸位置包括右侧148例，左侧129例，双侧16例。治疗方法包括胸腔闭式引流282例，开胸胸膜摩擦固定术39例，正中开胸双侧胸膜摩擦固定术31例，化学性胸膜固定术18例。胸膜固定术的适应证包括：（1）复发性气胸；（2）双侧气胸；（3）持续漏气超过7天；（4）大量漏气；（5）气胸并发症。通过我们的研究，我们得出以下结论：（1）自发性气胸最简单的治疗方法是胸腔闭式引流。（2）对于年轻成年人或可疑双侧病变患者，在某些特殊适应证下，正中开胸双侧胸膜摩擦固定术是首选治疗方法。（3）对于老年患者或因其他肺部疾病需要同时进行手术的患者，开胸胸膜摩擦固定术是更好的选择。（4）当肺功能较差且禁忌手术时，化学性胸膜固定术也可取得一定疗效。
