Department of Thoracic Surgery, Chaim Sheba Medical Center, Tel Hashomer, 52621, Israel.
World J Surg. 2011 Nov;35(11):2563-7. doi: 10.1007/s00268-011-1207-3.
Recurrent spontaneous pneumothorax is widely treated by video-assisted thoracoscopic (VATS) bullectomy and pleurodesis. Treatment of postoperative pain with nonsteroidal antiinflammatory drugs (NSAIDs) is controversial as many surgeons believe that it reduces the efficacy of pleurodesis and increases the pneumothorax recurrence rate.
In this retrospective study, we reviewed the hospital records for patients following VATS pleurodesis for recurrent spontaneous pneumothorax. The patients were divided into two groups: (1) NSAID group: patients were treated with NSAIDs for more than a week following surgery and (2) control group: patients did not receive NSAIDs. Data regarding short- and long-term outcomes were compared.
The study cohort included 105 patients: 48 in the NSAID group and 57 in the control group. During the early postoperative period the average daily requirement of narcotic analgesia and the incidence of narcotic-related side effects were lower in the NSAIDs group. No difference was found in the long-term recurrence rate: two of 48 (4%) in the NSAID group and three of 57 (5%) in the control group. There was one case of early recurrence in the NSAID group. Both groups had similar length of stay with no cases of mortality or major morbidity.
NSAIDs for postsurgical pleurodesis pain obviates the need for narcotics without increasing the pneumothorax recurrence rate. Prospective randomized controlled studies are needed to further investigate this issue.
复发性自发性气胸广泛采用电视辅助胸腔镜（VATS）肺大疱切除术和胸膜固定术治疗。许多外科医生认为，使用非甾体抗炎药（NSAIDs）治疗术后疼痛会降低胸膜固定术的疗效并增加气胸复发率，因此 NSAIDs 的使用存在争议。
在这项回顾性研究中，我们查阅了 VATS 胸膜固定术治疗复发性自发性气胸患者的住院记录。患者分为两组：（1）NSAID 组：术后使用 NSAIDs 治疗超过一周；（2）对照组：未使用 NSAIDs。比较两组患者的短期和长期结果数据。
研究队列包括 105 例患者：NSAID 组 48 例，对照组 57 例。在术后早期，NSAIDs 组的平均每日阿片类药物需求和阿片类药物相关副作用的发生率较低。两组气胸复发率无差异：NSAID 组有 2 例（4%），对照组有 3 例（5%）。NSAID 组有 1 例早期复发。两组的住院时间相似，均无死亡或严重并发症病例。
对于胸膜固定术后疼痛，使用 NSAIDs 可以避免使用阿片类药物，而不会增加气胸复发率。需要前瞻性随机对照研究来进一步探讨这个问题。
