Yang Wendy, Chang Pei-Yeh, Yeh Ai-Hua, Ming Yung-Ching, Chen Jeng Chang, Lai Jin-Yao
Department of Pediatric Surgery, Chang Gung Children's Hospital, Chang Gung University, College of Medicine, Linkou, Taiwan.
Department of Pediatric Surgery, Chang Gung Children's Hospital, Chang Gung University, College of Medicine, Linkou, Taiwan.
Pediatr Neonatol. 2019 Feb;60(1):83-86. doi: 10.1016/j.pedneo.2018.04.009. Epub 2018 May 3.
Video-assisted thoracoscopic bullectomy with pleurodesis is widely used to treat spontaneous pneumothorax. However, 1%-3% of patients experience postoperative complications that may require reoperation, such as bleeding or prolonged air leaks, and 3%-7% of patients require a repeat thoracoscopic bullectomy due to recurrence. Therefore, a modified procedure with improved outcomes is required.
Between January 1, 2011 and December 31, 2015, 196 patients with spontaneous pneumothorax underwent thoracoscopic bullectomy and pleurodesis with or without fixation of the lung apex to the chest wall. In patients in the fixation group, the lung apex was fixed to the chest wall with two non-absorbable sutures after bullectomy and pleurodesis. The treatment of each lung was considered an independent operation in patients with bilateral spontaneous pneumothorax.
The patients in each group had comparable backgrounds. In the fixation group, 67 patients underwent 87 operations, four of which (in three patients) led to recurrences (recurrence rate, 4.60%). There were no readmissions or reoperations within 30 days in this group. In the non-fixation group, 128 patients underwent 161 operations, 14 of which (in nine patients) led to recurrences (recurrence rate, 8.7%). In addition, three patients in this group required reoperation and two were readmitted within 30 days.
Modified thoracoscopic bullectomy with fixation of the lung apex is a safe procedure that provides better outcomes with lower complication rates.
电视辅助胸腔镜肺大疱切除术加胸膜固定术广泛用于治疗自发性气胸。然而，1% - 3%的患者会出现术后并发症，可能需要再次手术，如出血或持续性漏气，3% - 7%的患者因复发需要再次进行胸腔镜肺大疱切除术。因此，需要一种能改善治疗效果的改良手术方法。
在2011年1月1日至2015年12月31日期间，196例自发性气胸患者接受了胸腔镜肺大疱切除术和胸膜固定术，部分患者同时进行或未进行肺尖与胸壁固定。在固定组患者中，肺大疱切除和胸膜固定术后，用两根不可吸收缝线将肺尖固定于胸壁。双侧自发性气胸患者，每侧肺的治疗被视为独立手术。
两组患者的背景具有可比性。在固定组，67例患者接受了87次手术，其中4次手术（3例患者）导致复发（复发率4.60%）。该组30天内无再次入院或再次手术情况。在非固定组，128例患者接受了161次手术，其中14次手术（9例患者）导致复发（复发率8.7%）。此外，该组有3例患者需要再次手术，2例在30天内再次入院。
改良胸腔镜肺大疱切除术加肺尖固定术是一种安全的手术方法，能以较低的并发症发生率取得更好的治疗效果。
