Tsuboshima Kenji, Kurihara Masatoshi, Yamanaka Takahiro, Watanabe Kenichi, Matoba Yasumi, Seyama Kuniaki
Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, 4-8-1 Seta Setagaya-ku, Tokyo, 158-0095, Japan.
Department of Surgery, Takasago Municipal Hospital, Hyogo, Japan.
Gen Thorac Cardiovasc Surg. 2020 Aug;68(8):741-745. doi: 10.1007/s11748-020-01388-1. Epub 2020 May 27.
Primary spontaneous pneumothorax is relatively rarer in women than in men. In addition, women develop secondary spontaneous pneumothorax, such as lymphangioleiomyomatosis, which is rare and difficult to diagnose. Therefore, the clinical characteristics of primary spontaneous pneumothorax in women remain unknown presently. We compared the clinical characteristics of primary spontaneous pneumothorax between the two sexes at two pneumothorax centers.
Between January 2015 and July 2019, we retrospectively evaluated 627 cases (106 women and 521 men) who underwent first video-assisted thoracoscopic surgery for primary spontaneous pneumothorax and extracted the medical backgrounds and postoperative recurrence between the sexes. Univariate and multivariate analysis was used to examine the effect of sexual specificity on postoperative recurrence.
Among women and men with PSP, the mean ages were 27.8 ± 10.7 and 24.3 ± 10.0 years, respectively; their mean heights were 162.0 ± 5.9 and 173.3 ± 6.1 cm, respectively. These differences were statistically significant. Three women (2.8%) and 54 men (10.4%) developed postoperative recurrence, which showed significant difference on Kaplan-Meier analysis (p = 0.027). Univariate and multivariate analysis showed the factors; women (p = 0.045, hazard ratio: 0.289 [95% confidence interval 0.086-0.973]) and smoker (p = 0.035, hazard ratio: 0.269 [95% confidence interval 0.079-0.909]) had the preventing factor for postoperative recurrence, respectively.
Women with PSP had lower postoperative recurrence rate than men. Although we could not reveal why women had lower postoperative recurrence rates than men in this study, the sexual difference such as hormonal cycle, development of body structure possibly affects the clinical characteristics of women with primary spontaneous pneumothorax.
原发性自发性气胸在女性中相对比男性少见。此外，女性会发生继发性自发性气胸，如淋巴管平滑肌瘤病，这种疾病罕见且难以诊断。因此，目前女性原发性自发性气胸的临床特征仍不清楚。我们在两个气胸中心比较了两性原发性自发性气胸的临床特征。
2015年1月至2019年7月，我们回顾性评估了627例行首次电视辅助胸腔镜手术治疗原发性自发性气胸的病例（106例女性和521例男性），并提取了两性的医学背景和术后复发情况。采用单因素和多因素分析来检验性别特异性对术后复发的影响。
患有原发性自发性气胸的女性和男性的平均年龄分别为27.8±10.7岁和24.3±10.0岁；他们的平均身高分别为162.0±5.9厘米和173.3±6.1厘米。这些差异具有统计学意义。3名女性（2.8%）和54名男性（10.4%）发生了术后复发，在Kaplan-Meier分析中显示出显著差异（p = 0.027）。单因素和多因素分析显示了相关因素；女性（p = 0.045，风险比：0.289 [95%置信区间0.086 - 0.973]）和吸烟者（p = 0.035，风险比：0.269 [95%置信区间0.079 - 0.909]）分别是术后复发的预防因素。
患有原发性自发性气胸的女性术后复发率低于男性。尽管在本研究中我们无法揭示女性术后复发率低于男性的原因，但诸如激素周期、身体结构发育等性别差异可能会影响女性原发性自发性气胸的临床特征。
