Ikeda M, Uno A, Yamane Y, Hagiwara N
Department of Respiratory Surgery, Iwaki-Kyouritsu General Hospital, Iwaki-City, Japan.
J Thorac Cardiovasc Surg. 1988 Oct;96(4):615-20.
Simultaneous bilateral pulmonary operations were done through median sternotomy in 29 patients with unilateral spontaneous pneumothorax, because bullae and blebs of the lung are frequently bilateral. Bullous lesions on the contralateral lung were encountered in eight of 10 patients (80%) in whom no roentgenographic evidence of the additional lesions had been detected preoperatively. Postoperative examination of percent vital capacity was satisfactory (more than 80%) in 21 of 23 patients followed up over a month after operation, and this suggested that simultaneous bilateral thoracotomy through median sternotomy does not lead to a much greater decrease in postoperative pulmonary function than does unilateral operation. To determine the indications for this method of treatment, we investigated the frequency of subsequent development of contralateral pneumothorax in 178 patients who initially had unilateral spontaneous pneumothorax. The occurrence rate of contralateral pneumothorax with visible bullae on chest roentgenograms was as high as 60% and 33.3% in patients in their teens and in those in their 20s, respectively. In conclusion, therefore, the bilateral operative approach should be considered, especially in teenaged patients with contralateral bullae, in whom the highest contralateral occurrence rate of 60% was found.
29例单侧自发性气胸患者通过正中胸骨切开术进行了同期双侧肺部手术，因为肺大疱和肺小疱常常是双侧的。术前胸部X线检查未发现额外病变的10例患者中，有8例（80%）在对侧肺发现了大疱性病变。术后随访1个月以上的23例患者中，有21例（21/23）的术后肺活量百分比检查结果令人满意（超过80%），这表明通过正中胸骨切开术同期进行双侧开胸手术相比单侧手术，术后肺功能下降幅度并不会大很多。为了确定这种治疗方法的适应症，我们调查了178例最初患有单侧自发性气胸的患者对侧气胸后续发生的频率。胸部X线片上可见肺大疱的患者中，十几岁的患者对侧气胸发生率高达60%，二十多岁的患者为33.3%。因此，总之，应考虑采用双侧手术方法，尤其是对于对侧有肺大疱的青少年患者，此类患者对侧气胸发生率最高，达60%。
