Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA.
J Pediatr Surg. 2011 Aug;46(8):1523-5. doi: 10.1016/j.jpedsurg.2011.01.002.
Spontaneous pneumothorax may result from rupture of subpleural blebs. Computed tomography (CT) has been used to identify blebs to serve as an indication for thoracoscopy. We reviewed our experience with spontaneous pneumothorax to assess the utility of CT in these patients.
A retrospective review was conducted of all patients who underwent an operation for spontaneous pneumothorax from January 1999 to October 2009. All procedures were performed thoracoscopically.
We identified 39 pneumothoraces in 34 patients who underwent evaluation and a procedure for spontaneous pneumothorax. Mean age was 16.1 years (range, 10-23 years), with an average of 1.7 spontaneous pneumothoraces before operation (range, 1-4). Preoperative chest CT scans were obtained in 26 cases. Blebs were demonstrated on 8 CT scans. The presence of blebs was confirmed at operation in all 8 patients. Of the 18 negative scans, 14 (77.8%) were found to have blebs intraoperatively, 7 of these patients were initially managed nonoperatively and developed recurrence. The sensitivity of CT for identifying blebs was 36%.
Chest CT does not appear to be precise in the identification of pleural blebs and a negative examination does not predict freedom from recurrence. Operative decisions should be based on clinical judgment without the use of preoperative CT.
自发性气胸可由胸膜下疱破裂引起。计算机断层扫描（CT）已被用于识别疱，作为胸腔镜检查的指征。我们回顾了自发性气胸患者的经验，以评估 CT 在这些患者中的应用价值。
对 1999 年 1 月至 2009 年 10 月期间因自发性气胸接受手术的所有患者进行回顾性分析。所有手术均经胸腔镜进行。
我们共发现 34 例患者的 39 例气胸，这些患者均接受了自发性气胸的评估和手术。平均年龄为 16.1 岁（范围，10-23 岁），平均术前自发性气胸发作 1.7 次（范围，1-4 次）。26 例患者术前进行了胸部 CT 扫描。8 例 CT 扫描显示疱。在所有 8 例患者中，均在手术中证实存在疱。在 18 例阴性扫描中，14 例（77.8%）在手术中发现疱，其中 7 例最初接受非手术治疗，后来复发。CT 识别疱的敏感性为 36%。
胸部 CT 似乎不能准确识别胸膜疱，阴性检查并不能预测无复发。手术决策应基于临床判断，而不使用术前 CT。
