Ota Hideki, Kawai Hideki, Kuriyama Syouji
Department of Thoracic Surgery, Akita Red Cross Hospital, Akita, Akita, Japan.
Ann Thorac Cardiovasc Surg. 2016 Jun 20;22(3):139-45. doi: 10.5761/atcs.oa.15-00306. Epub 2016 Feb 12.
Deteriorated alveolar structure at the base of blebs and bullae is known as the reticulated trabecula-like structure. Its clinical significance in primary spontaneous pneumothorax (PSP) remains unclear. This study aimed to investigate the impact of the structure on recurrence of PSP after video-assisted thoracoscopic surgery (VATS) bullectomy.
Between April 2010 and March 2014, 80 cases of PSP in 76 patients who underwent VATS bullectomy using endoscopic staplers were included. The staple line was covered with polyglycolic acid sheets and fibrin glue. Cases were assigned to a normal alveolar structure (NAS) group (n = 54) and a reticulated trabecula-like structure (RT) group (n = 26) based on the histological analysis. Factors associated with recurrence were analysed using logistic regression.
The reticulated trabecula-like structure was significantly related to apical lung blebs. The recurrence rate of PSP was significantly higher in the RT group than in the NAS group (38.5% vs. 3.7%; P <0.001). On multivariate analysis, the reticulated trabecula-like structure was an independent factor for recurrence of PSP after VATS bullectomy.
The change of alveolar structure at the base of apical lung blebs would increase the risk for recurrence of PSP after VATS bullectomy.
肺大疱底部肺泡结构恶化被称为网状小梁样结构。其在原发性自发性气胸（PSP）中的临床意义尚不清楚。本研究旨在探讨该结构对电视辅助胸腔镜手术（VATS）肺大疱切除术后PSP复发的影响。
2010年4月至2014年3月，纳入76例接受VATS肺大疱切除术的PSP患者共80例。吻合器缝线处覆盖聚乙醇酸片和纤维蛋白胶。根据组织学分析将病例分为正常肺泡结构（NAS）组（n = 54）和网状小梁样结构（RT）组（n = 26）。采用逻辑回归分析与复发相关的因素。
网状小梁样结构与肺尖部肺大疱显著相关。RT组PSP复发率显著高于NAS组（38.5%对3.7%；P <0.001）。多因素分析显示，网状小梁样结构是VATS肺大疱切除术后PSP复发的独立因素。
肺尖部肺大疱底部肺泡结构的改变会增加VATS肺大疱切除术后PSP复发的风险。
