Haga Takahiro, Kurihara Masatoshi, Kataoka Hideyuki
Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, Japan.
Intern Med. 2013;52(19):2189-92. doi: 10.2169/internalmedicine.52.0732. Epub 2012 Mar 1.
Prolonged air leaks in patients with spontaneous pneumothorax are not infrequent. The aim of this study was to assess the duration of air leaks and define the clinical variables associated with the therapeutic success of chest tube drainage for spontaneous pneumothorax.
A total of 441 patients with spontaneous pneumothorax treated with chest tube drainage between 2008 and 2012 were retrospectively evaluated. The clinical differences between the patients successfully treated with drainage and those who required more invasive procedures were analyzed.
Invasive procedures, such as video-assisted thoracic surgery (n=121), fibrin glue administration through a chest tube (n=8) and pleurodesis with OK-432 (n=21), were performed in 34% (150/441) of the patients. The treatment rate of chest drainage alone was higher in the patients with initial pneumothorax (72%; 124/170) than in those with recurrent pneumothorax (62%; 167/271) (p=0.015). In addition, this rate was higher in the patients with moderate lung collapse (70%; 167/237) than in those with severe lung collapse (61%; 124/204) (p=0.032).
Patients with recurrent pneumothorax or severe lung collapse associated with prolonged air leakage are more likely to receive invasive procedures.
自发性气胸患者出现长时间漏气的情况并不少见。本研究旨在评估漏气持续时间，并确定与自发性气胸胸腔闭式引流治疗成功相关的临床变量。
对2008年至2012年间接受胸腔闭式引流治疗的441例自发性气胸患者进行回顾性评估。分析了胸腔闭式引流治疗成功的患者与需要更具侵入性治疗的患者之间的临床差异。
34%（150/441）的患者接受了诸如电视辅助胸腔手术（n = 121）、通过胸腔闭式引流注入纤维蛋白胶（n = 8）以及使用OK-432进行胸膜固定术（n = 21）等侵入性治疗。首次发生气胸的患者单纯胸腔闭式引流治疗成功率（72%；124/170）高于复发性气胸患者（62%；167/271）（p = 0.015）。此外，中度肺萎陷患者的这一治疗成功率（70%；167/237）高于重度肺萎陷患者（61%；124/204）（p = 0.032）。
复发性气胸或伴有长时间漏气的重度肺萎陷患者更有可能接受侵入性治疗。
