Service de pneumologie, centre de compétences pour les maladies pulmonaires rares, Hôpital Pontchaillou, Rennes, France.
Service de pneumologie, Hôpital du Scorff, Lorient, France.
Respir Med. 2020 May;166:105931. doi: 10.1016/j.rmed.2020.105931. Epub 2020 Mar 16.
Spontaneous pneumothorax occurs most frequently in young active patients. Published guidelines do not all agree about its initial management; most patients are hospitalised and treated with chest tube. This prospective multicentric cohort study was designed to assess the potential of ambulatory management.
We included all consecutive patients with large spontaneous primary (PSP) and secondary pneumothoraces (SSP) presenting at the Lorient, Vitré and Rennes hospitals between December 2013 and July 2016. They were treated with a small-bore pigtail catheter and one-way valve and managed as outpatients following a specific protocol. When this failed, patients were hospitalised on day 4 for suction and surgical pleurodesis was envisaged on day 6. Patients were followed-up for one-year to assess relapse.
Of the 148 patients included (129 PSP, 19 SSP), 122 (82⋅4%) were managed exclusively as outpatient with success in 84⋅5% of PSP and 68⋅4% of SSP patients. There were few complications: 13 vaso-vagal episodes and 3 minor bleedings. The one-year recurrence rates were 33⋅1% for PSP and 52⋅6% for SSP (p = 0⋅114 Hazard Ratio = 0⋅538; IC95% [0⋅249-1⋅161]).
These results are consistent with our previous study and confirm that this exclusive ambulatory management of spontaneous pneumothoraces can be successfully implemented in new centres with a high success rate and few complications.
自发性气胸最常发生于年轻活跃的患者。发表的指南并非都对其初始治疗达成一致；大多数患者被收入院并接受胸腔引流管治疗。本前瞻性多中心队列研究旨在评估门诊管理的潜力。
我们纳入了 2013 年 12 月至 2016 年 7 月期间在洛里昂、维特雷和雷恩医院就诊的所有连续的大型原发性（PSP）和继发性（SSP）自发性气胸患者。他们接受了小口径猪尾导管和单向活瓣治疗，并根据特定方案进行门诊管理。如果失败，患者将在第 4 天住院进行抽吸，如果第 6 天预计需要手术胸膜固定术，则将住院治疗。对患者进行为期一年的随访以评估复发情况。
148 例患者中（129 例 PSP，19 例 SSP），122 例（82.4%）仅作为门诊患者进行管理，84.5%的 PSP 和 68.4%的 SSP 患者成功。并发症较少：13 例血管迷走神经性发作和 3 例轻微出血。PSP 的一年复发率为 33.1%，SSP 为 52.6%（p=0.114，风险比=0.538；95%CI [0.249-1.161]）。
这些结果与我们之前的研究一致，证实了这种自发性气胸的独家门诊管理可以在新中心成功实施，成功率高，并发症少。
