Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 10002, Taiwan.
Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, 10055, Taiwan.
Sci Rep. 2017 Mar 15;7(1):181. doi: 10.1038/s41598-017-00284-8.
Small-bore thoracic catheter drainage is recommended for a first large or symptomatic episode of primary spontaneous pneumothorax (PSP). However, one-third of these patients require a second procedure because of treatment failure. We investigated the factors associated with unsuccessful pigtail catheter drainage in the management of PSP. In this retrospective study, using a prospectively collected database, we enrolled 253 consecutive patients with PSP who underwent pigtail catheter drainage as initial treatment, from December 2006 to June 2011. The chest radiograph was reviewed in each case and pneumothorax size was estimated according to Light's index. Other demographic factors and laboratory data were collected via chart review. Pigtail catheter drainage was successful in 71.9% (182/253) of cases. Treatment failure rates were 42.9%, 25.9%, and 15.5% in patients with pneumothorax sizes of >62.6%, 38-62.6%, and <38%, respectively (tertiles). An alternative cut-off point of 92.5% lung collapse was defined using a classification and regression tree method. According to the multivariate analysis, a large-size pneumothorax (p = 0.009) was the only significant predictor of initial pigtail catheter drainage treatment failure in patients with PSP. Early surgical treatment could be considered for those patients with a large-sized pneumothorax.
小口径胸腔导管引流推荐用于初次大疱性或症状性原发性自发性气胸（PSP）。然而，这些患者中有三分之一由于治疗失败需要进行第二次手术。我们研究了与 PSP 管理中猪尾导管引流失败相关的因素。在这项回顾性研究中，我们使用前瞻性收集的数据库纳入了 2006 年 12 月至 2011 年 6 月期间接受猪尾导管引流作为初始治疗的 253 例连续 PSP 患者。对每个病例的胸部 X 线片进行了复查，并根据 Light 指数估计气胸大小。通过图表回顾收集了其他人口统计学因素和实验室数据。71.9%（182/253）的病例中猪尾导管引流成功。气胸大小>62.6%、38-62.6%和<38%的患者中，治疗失败率分别为 42.9%、25.9%和 15.5%（三分位数）。使用分类和回归树方法定义了另一个 92.5%肺萎陷的截断点。根据多变量分析，气胸大（p=0.009）是 PSP 患者初始猪尾导管引流治疗失败的唯一显著预测因素。对于气胸较大的患者，可以考虑早期手术治疗。
