Chew Rusheng, Gerhardy Benjamin, Simpson Graham
Department of Thoracic Medicine Cairns Base Hospital Cairns Australia.
James Cook University School of Medicine and Dentistry Cairns Australia.
Acute Med Surg. 2014 May 19;1(4):195-199. doi: 10.1002/ams2.33. eCollection 2014 Oct.
The best management of primary spontaneous pneumothorax is unclear. Conservative treatment has been proposed, but no studies comparing conservative with invasive management have been carried out where pneumothorax size has been numerically quantified. This study aimed to evaluate the feasibility of conservative management for primary spontaneous pneumothoraces of any size.
Retrospective cohort study of adult patients with primary spontaneous pneumothorax treated at an Australian tertiary hospital from 2006-2011, carried out by case-note and chest radiograph review. Patient demographics, smoking status, and outcome data were collected. Pneumothorax size was calculated using the Collins method, based on the sum of interpleural distances.
One hundred and twenty-seven episodes from 116 patients were identified. Males (86) comprised 75% of patients, and the median age at presentation was 37 years. Eighty-two percent of cases (106) were ever-smokers. Of the episodes in which pre-treatment radiographs were available, 53 were treated conservatively and 58 invasively with tube thoracostomy, and all were clinically stable. When cases were stratified by pneumothorax size, age, sex, ethnicity, and smoking status had no effect on outcome. Compared to invasive treatment, conservative management resulted in no complications, an equal recurrence rate, and a significantly shorter length of stay.
Our results suggest that it may be feasible to adopt a conservative approach as the first-line treatment of primary spontaneous pneumothorax in clinically stable patients. However, given the limitations of this study, a large randomised controlled trial is required to conclusively prove this assertion.
原发性自发性气胸的最佳治疗方法尚不清楚。有人提出采用保守治疗，但尚未开展将保守治疗与侵入性治疗进行比较的研究，其中气胸大小进行了数值量化。本研究旨在评估对任何大小的原发性自发性气胸进行保守治疗的可行性。
对2006年至2011年在澳大利亚一家三级医院接受治疗的成年原发性自发性气胸患者进行回顾性队列研究，通过病例记录和胸部X光片复查进行。收集患者的人口统计学资料、吸烟状况和结局数据。基于胸膜间距离之和，采用柯林斯方法计算气胸大小。
共识别出116例患者的127次发作。男性患者86例（占75%），就诊时的中位年龄为37岁。82%的病例（106例）曾吸烟。在有治疗前X光片的发作中，53例采用保守治疗，58例采用胸腔闭式引流术进行侵入性治疗，所有患者临床均稳定。按气胸大小、年龄、性别、种族和吸烟状况对病例进行分层时，这些因素对结局均无影响。与侵入性治疗相比，保守治疗无并发症，复发率相同，住院时间显著缩短。
我们的结果表明，对于临床稳定的原发性自发性气胸患者，采用保守方法作为一线治疗可能是可行的。然而，鉴于本研究的局限性，需要进行一项大型随机对照试验来最终证实这一观点。
