Schneider Lisa F, Albornoz Claudia R, Huang James, Cordeiro Peter G
From the *Division of Plastic and Reconstructive Surgery and †Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
Ann Plast Surg. 2014 Sep;73(3):279-81. doi: 10.1097/SAP.0b013e31827e2936.
Iatrogenic pneumothorax is a serious intraoperative complication of immediate breast reconstruction with tissue expanders. However, there is paucity of literature regarding incidence or management of intraoperative pneumothorax in the breast reconstruction patient population.
We performed a retrospective chart review on prospectively collected data from all patients undergoing immediate breast reconstruction with tissue expanders from 1992 to 2012 to determine institutional incidence. We also searched the Nationwide Inpatient Sample database from 1998 to 2008 to determine national incidence.
A total of 9653 tissue expanders were placed in 6955 patients at the Memorial Sloan Kettering Cancer Center between 1992 and 2012. There were 3 cases of pneumothorax during immediate breast reconstruction with tissue expanders. The incidence of pneumothorax is 0.03% per expander and 0.04% per patient. From the national database, there were 153 cases of pneumothorax during immediate breast reconstruction with tissue expanders in 27,612 patients. The overall national incidence of pneumothorax is 0.55% per patient.
Our algorithm for management includes a thoracic surgery consultation intraoperatively. A chest tube should be placed at a site distal to the pleurotomy. The site of injury should be repaired primarily or patched as necessary. If the patient remains stable, it is safe to proceed with placement of the tissue expander.
医源性气胸是使用组织扩张器进行即刻乳房重建术中一种严重的并发症。然而，关于乳房重建患者群体中术中气胸的发生率或处理方法的文献较少。
我们对1992年至2012年期间所有使用组织扩张器进行即刻乳房重建的患者的前瞻性收集数据进行回顾性病历审查，以确定机构发生率。我们还检索了1998年至2008年的全国住院患者样本数据库，以确定全国发生率。
1992年至2012年期间，纪念斯隆凯特琳癌症中心共为6955例患者植入了9653个组织扩张器。在使用组织扩张器进行即刻乳房重建期间发生了3例气胸。气胸的发生率为每个扩张器0.03%，每位患者0.04%。从全国数据库中可知，在27612例使用组织扩张器进行即刻乳房重建的患者中发生了153例气胸。全国气胸的总体发生率为每位患者0.55%。
我们的处理方案包括术中请胸外科会诊。应在胸膜切开术远端放置胸管。损伤部位应根据需要进行一期修复或修补。如果患者保持稳定，继续植入组织扩张器是安全的。
