Fiorelli Alfonso, D'Andrilli Antonio, Cascone Roberto, Occhiati Luisa, Anile Marco, Diso Daniele, Cassiano Francesco, Poggi Camilla, Ibrahim Mohsen, Cusumano Giacomo, Terminella Alberto, Failla Giuseppe, La Sala Alba, Bezzi Michela, Innocenti Margherita, Torricelli Elena, Venuta Federico, Rendina Erino Angelo, Vicidomini Giovanni, Santini Mario, Andreetti Claudio
Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy.
Thoracic Surgery Unit, Università La Sapienza, Sant'Andrea Hospital, Rome, Italy.
J Thorac Dis. 2018 Nov;10(11):6158-6167. doi: 10.21037/jtd.2018.10.61.
To evaluate the efficacy of Endo-Bronchial Valves in the management of persistent air-leaks (PALs) and the procedural cost.
It was a retrospective multicenter study including consecutive patients with PALs for alveolar pleural fistula (APF) undergoing valve treatment. We assessed the efficacy and the cost of the procedure.
Seventy-four patients with persistent air leaks due to various etiologies were included in the analysis. In all cases the air leaks were severe and refractory to standard treatments. Sixty-seven (91%) patients underwent valve treatment obtaining a complete resolution of air-leaks in 59 (88%) patients; a reduction of air-leaks in 6 (9%); and no benefits in 2 (3%). The comparison of data before and after valve treatment showed a significant reduction of air-leak duration (16.2±8.8 versus 5.0±1.7 days; P<0.0001); chest tube removal (16.2±8.8 versus 7.3±2.7 days; P<0.0001); and length of hospital stay (LOS) (16.2±8.8 versus 9.7±2.8 days; P=0.004). Seven patients not undergoing valve treatment underwent pneumo-peritoneum with pleurodesis (n=6) or only pleurodesis (n=1). In only 1 (14%) patient, the chest drainage was removed 23 days later while the remaining 6 (86%) were discharged with a domiciliary chest drainage removed after 157±41 days. No significant difference was found in health cost before and after endobronchial valve (EBV) implant (P=0.3).
Valve treatment for persistent air leaks is an effective procedure. The reduction of hospitalization costs related to early resolution of air-leaks could overcome the procedural cost.
评估支气管内瓣膜在治疗持续性漏气（PALs）中的疗效及手术成本。
这是一项回顾性多中心研究，纳入了因肺泡胸膜瘘（APF）导致持续性漏气且接受瓣膜治疗的连续患者。我们评估了该手术的疗效和成本。
分析纳入了74例因各种病因导致持续性漏气的患者。所有病例中的漏气均严重且对标准治疗无效。67例（91%）患者接受了瓣膜治疗，其中59例（88%）患者的漏气完全消失；6例（9%）患者的漏气减少；2例（3%）患者无获益。瓣膜治疗前后的数据比较显示，漏气持续时间显著缩短（16.2±8.8天对5.0±1.7天；P<0.0001）；胸管拔除时间显著缩短（16.2±8.8天对7.3±2.7天；P<0.0001）；住院时间（LOS）显著缩短（16.2±8.8天对9.7±2.8天；P=0.004）。7例未接受瓣膜治疗的患者接受了气腹胸膜固定术（n=6）或仅接受了胸膜固定术（n=1）。仅1例（14%）患者在23天后拔除了胸腔引流管，其余6例（86%）患者出院时带家庭胸腔引流管，157±41天后拔除。支气管内瓣膜（EBV）植入前后的医疗成本无显著差异（P=0.3）。
瓣膜治疗持续性漏气是一种有效的手术方法。因漏气早期解决而降低的住院成本可能会超过手术成本。
