Wakabayashi A, Brenner M, Wilson A F, Tadir Y, Berns M
Department of Surgery, University of California, Irvine.
Ann Thorac Surg. 1990 Nov;50(5):786-9; discussion 789-90.
In an effort to improve the success rate of the previously described thoracoscopic electrocautery ablation technique of spontaneous pneumothorax, the carbon dioxide laser was evaluated in 12 patients. The recurrent (5 patients) or persistent (7 patients) spontaneous pneumothoraces were caused by rupture of (1) blebs in 6 patients, (2) intrapulmonary apical type II bullae in 3 patients, and (3) diffuse bullous emphysema, type III, in 3. The air leaks were successfully sealed in all but 1 patient with ruptured type II bulla. Surgical specimen from this single failure suggested that the entire inner lining of the bullae must be thermocoagulated. This technical modification led to successful outcome in 2 subsequent cases. With the use of carbon dioxide laser, it was possible to treat not only small blebs but all types of bullae causing spontaneous pneumothorax. Laser thoracoscopy is effective and safe in treating spontaneous pneumothorax.
为提高先前所述的胸腔镜电灼消融治疗自发性气胸技术的成功率，对12例患者进行了二氧化碳激光评估。复发性（5例）或持续性（7例）自发性气胸由以下原因导致：（1）6例患者的肺大疱破裂，（2）3例患者的肺内尖部II型肺大疱，以及（3）3例患者的III型弥漫性肺大疱肺气肿。除1例II型肺大疱破裂患者外，所有患者的漏气均成功封闭。该例失败患者的手术标本提示，肺大疱的整个内衬必须进行热凝。这一技术改进在随后的2例患者中取得了成功。使用二氧化碳激光不仅可以治疗小的肺大疱，还可以治疗导致自发性气胸的所有类型的肺大疱。激光胸腔镜治疗自发性气胸有效且安全。
