Zhang H, Wang L, Ge C S, Bu X C, Sun Z M, Zhang W, Duan C L, Xue G W
Rizhao City Hospital of Traditional Chinese Medicine, Rizhao 276800, China.
Zhonghua Yi Xue Za Zhi. 2018 Aug 14;98(30):2448-2451. doi: 10.3760/cma.j.issn.0376-2491.2018.30.016.
To evaluate the preliminary efficacy and safety of argon plasma coagulation (APC) plus medical adhesive via thoracoscopy in the treatment of spontaneous pneumothorax caused by subpleural blebs. Data of totally 51 patients of spontaneous pneumothorax with subpleural blebs treated in Pneumology Department of Rizhao Hospital of Traditional Chinese Medicine from July 2015 to July 2017 were retrospectively analyzed. Among the 51 patients, 59 target bullae were found, 1.2 per patient on average, with the diameter ranging from 0.5 to 5 cm and an average diameter of 2.6 cm. A total of 21 patients were treated with APC, and the rest 30 were treated with APC plus partially sprayed medical adhesive (APC+ group). The rate of air leakage discontinuance within 24 hours after operation, the rate of air leakage discontinuance within one week after operation, the disappearance rate of target subpleural blebs on CT scans one week after operation, and the rate of significantly shrunken target subpleural blebs and wall thickness, as well as the incidence of postoperative complications, including fever, chest pain, pleural effusion, hemorrhage, and infection after operation were observed and compared between the two groups. The air leakage discontinuance rate in APC+ group was significantly higher than that in APC group 24 hours after operation (90.0% vs 52.4%, <0.05), and the rate in APC+ group was also significantly higher than that in APC group one week after operation (96.7% vs 66.8%, <0.05). There was no significant difference in the disappearance rate of target subpleural blebs on CT scans one week after operation and the incidence of significantly shrunken target subpleural blebs and wall thickness (both >0.05). There was no significant difference in the incidence of postoperative complications such as fever, chest pain and pleural effusion (all >0.05). The treatment of spontaneous pneumothorax with subpleural blebs by APC plus medical adhesive is safe and effective.
评估胸腔镜下氩等离子体凝固术（APC）联合医用胶治疗胸膜下肺大疱所致自发性气胸的初步疗效及安全性。回顾性分析2015年7月至2017年7月日照市中医医院肺病科收治的51例胸膜下肺大疱所致自发性气胸患者的资料。51例患者中共发现59个目标肺大疱，平均每人1.2个，直径0.5～5 cm，平均直径2.6 cm。其中21例患者采用APC治疗，其余30例采用APC联合局部喷洒医用胶治疗（APC+组）。观察并比较两组患者术后24小时内漏气停止率、术后1周内漏气停止率、术后1周CT扫描目标胸膜下肺大疱消失率、目标胸膜下肺大疱显著缩小及壁厚度变化率，以及术后并发症（包括发热﹑胸痛﹑胸腔积液﹑出血和感染）的发生率。APC+组术后24小时漏气停止率显著高于APC组（90.0%比52.4%，P<0.05），术后1周APC+组漏气停止率也显著高于APC组（96.7%比66.8%，P<0.05）。术后1周CT扫描目标胸膜下肺大疱消失率及目标胸膜下肺大疱显著缩小及壁厚度变化率差异无统计学意义（均P>0.05）。发热﹑胸痛和胸腔积液等术后并发症发生率差异无统计学意义（均P>0.05）。APC联合医用胶治疗胸膜下肺大疱所致自发性气胸安全有效。
