Bilancia Rocco, Sharkey Annabel J, Paik Amit, Waller David A
Thoracic Surgery, Glenfield Hospital, Leicester, United Kingdom.
J Bronchology Interv Pulmonol. 2017 Jul;24(3):225-231. doi: 10.1097/LBR.0000000000000386.
The suggestion that spontaneous pneumothorax (SP) may result from diffuse porosity rather than discrete anatomic abnormality challenges the practice of targeted bullectomy. We assessed whether underlying pulmonary abnormalities are correlated or could be predicted from the mode of presentation, with potential implications for treatment.
We analyzed 192 consecutive video-assisted thoracoscopic surgery resections for SP (139 primary, 53 secondary) in 171 patients (115 male, age 36, range, 16 to 81). Presentation was categorized as: recurrent never drained (RND), recurrent drained, persistent air leak (PAL). Resected lung pathology was categorized as: no bleb/bulla, ruptured bleb/bulla, unruptured bleb/bulla.
No correlation between presentation and resected lung pathology was observed for primary (P=0.608) or secondary SP (P=0.597). A similar proportion of patients in each pathologic group presented with PAL or RND; ruptured bleb/bulla or no bleb/bulla was equally noted in PAL and RND group.
There is lack of association between resected lung pathology and mode of presentation. This suggests that discrete anatomic abnormalities may not be responsible for the air leak leading to pneumothorax. In conjunction with favorable reported outcomes from medical thoracoscopy and talc pleurodesis alone, these findings challenge the current practice of routine video-assisted thoracoscopic surgery lung resection in these patients.
关于自发性气胸（SP）可能由弥漫性孔隙而非离散性解剖异常引起的观点，对有针对性的肺大疱切除术的实践提出了挑战。我们评估了潜在的肺部异常是否与表现方式相关，或者能否从表现方式中预测出来，这对治疗可能具有重要意义。
我们分析了171例患者（115例男性，年龄36岁，范围16至81岁）连续进行的192例电视辅助胸腔镜手术治疗的SP（139例原发性，53例继发性）。表现方式分为：复发性未引流（RND）、复发性已引流、持续性漏气（PAL）。切除的肺病理分为：无肺大疱/肺气囊、破裂的肺大疱/肺气囊、未破裂的肺大疱/肺气囊。
原发性（P = 0.608）或继发性SP（P = 0.597）的表现方式与切除的肺病理之间未观察到相关性。每个病理组中出现PAL或RND的患者比例相似；PAL组和RND组中破裂的肺大疱/肺气囊或无肺大疱/肺气囊的情况相同。
切除的肺病理与表现方式之间缺乏关联。这表明离散性解剖异常可能不是导致气胸漏气的原因。结合单独使用内科胸腔镜和滑石粉胸膜固定术所报告的良好结果，这些发现对当前这些患者常规进行电视辅助胸腔镜手术肺切除的做法提出了挑战。
