Herrmann Dominik, Klapdor Benjamin, Ewig Santiago, Hecker Erich
Thoraxzentrum Ruhrgebiet, Department of Thoracic Surgery, Evangelisches Krankenhaus, Herne, Germany.
Thoraxzentrum Ruhrgebiet, Department of Respiratory and Infectious Diseases, Evangelisches Krankenhaus, Herne, Germany.
Eur J Cardiothorac Surg. 2016 Mar;49(3):854-9. doi: 10.1093/ejcts/ezv206. Epub 2015 Jun 20.
First-line conservative treatment of primary spontaneous pneumothorax (PSP) may be challenged by recurrence rates and complications associated with different treatment options. The aim of this study was to evaluate the use of a standardized surgical treatment as 'first-line' treatment.
In a 10-year period, 185 patients with PSP were treated with a standardized video-assisted thoracic surgery (VATS) approach including wedge resection and parietal pleurectomy. Data were evaluated retrospectively. All patients with a first event of PSP were included in the study. In addition, follow-up was done by a questionnaire.
Mean follow-up period was 70.8 months (±33.5 months). Sub-pleural emphysematous changes were found in every histopathological specimen. In addition, 70.8% had fibrosis of visceral pleura. Recurrence occurred in 4 patients (2.2%). Ten-year freedom from recurrence was 96.2%. Procedure-related morbidity rate was 7.6%. Approximately 85.7% of patients were satisfied with the procedure and the cosmetic result. Three patients died during follow-up (1.6%).
Treatment of first episode of PSP by VATS is a safe procedure, with a very low rate of recurrence and a high patient satisfaction. This management of first episode of PSP is based on the underlying pathology. We recommend the use of VATS as the treatment of first choice for patients with PSP.
原发性自发性气胸（PSP）的一线保守治疗可能会受到不同治疗方案的复发率和并发症的挑战。本研究的目的是评估将标准化手术治疗作为“一线”治疗的应用情况。
在10年期间，185例PSP患者接受了包括楔形切除术和壁层胸膜切除术在内的标准化电视辅助胸腔镜手术（VATS）治疗。对数据进行回顾性评估。所有首次发生PSP的患者均纳入本研究。此外，通过问卷调查进行随访。
平均随访期为70.8个月（±33.5个月）。在每个组织病理学标本中均发现了胸膜下肺气肿样改变。此外，70.8%的患者有脏层胸膜纤维化。4例患者复发（2.2%）。10年无复发率为96.2%。手术相关发病率为7.6%。约85.7%的患者对手术和美容效果满意。3例患者在随访期间死亡（1.6%）。
VATS治疗PSP的首次发作是一种安全的手术，复发率极低，患者满意度高。PSP首次发作的这种治疗方法基于潜在的病理学。我们建议将VATS作为PSP患者首选的治疗方法。
