Park Sungjoon, Jang Hyo Jun, Song Ju Hoon, Bae So Young, Kim Hyuck, Nam Seung Hyuk, Lee Jun Ho
Department of Thoracic and Cardiovascular Surgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Hanyang University Seoul Hospital, Seoul, Korea.
Korean J Thorac Cardiovasc Surg. 2019 Apr;52(2):91-99. doi: 10.5090/kjtcs.2019.52.2.91. Epub 2019 Apr 5.
The relationship between the size of bullae and pneumothorax recurrence is controversial. The aim of this study was to retrospectively evaluate the role of blebs or bullae in predicting ipsilateral recurrence in young patients experiencing their first episode of primary spontaneous pneumothorax (PSP) who underwent conservative treatment.
A total of 299 cases of first-episode PSP were analyzed. The status of blebs or bullae was reviewed on high-resolution computed tomography (HRCT). The dystrophic severity score (DSS; range, 0 to 6 points) was calculated based on HRCT.
The 5-year recurrence rate was 38.2%. In univariate analysis, age (<20 years), body mass index (<20 kg/m), a unilateral lesion, and intermediate risk (DSS 4 and 5) were associated with recurrence. Sex; smoking history; and the presence, number, and maximal size of blebs or bullae were not related to recurrence. In Cox regression, age and intermediate risk were independent risk factors for recurrence. High risk (DDS 6) was not an independent risk factor.
The presence, number, and size of blebs or bullae did not affect ipsilateral recurrence. DSS failed to show a positive correlation between severity and recurrence. The decision to perform surgery in patients experiencing their first episode of PSP should not be determined by the severity of blebs and bullae.
肺大疱大小与气胸复发之间的关系存在争议。本研究的目的是回顾性评估肺大疱在接受保守治疗的首次发生原发性自发性气胸（PSP）的年轻患者同侧复发预测中的作用。
共分析299例首次发作的PSP病例。通过高分辨率计算机断层扫描（HRCT）评估肺大疱的情况。根据HRCT计算营养不良严重程度评分（DSS；范围为0至6分）。
5年复发率为38.2%。单因素分析中，年龄（<20岁）、体重指数（<20kg/m²）、单侧病变和中度风险（DSS为4和5）与复发相关。性别、吸烟史以及肺大疱的存在、数量和最大尺寸与复发无关。在Cox回归分析中，年龄和中度风险是复发的独立危险因素。高风险（DDS 6）不是独立危险因素。
肺大疱的存在、数量和大小不影响同侧复发。DSS未能显示严重程度与复发之间的正相关。首次发作PSP的患者是否进行手术不应由肺大疱的严重程度决定。
