Keszler P
Department of General and Thoracic Surgery, Bajcsy-Zsilinszky-Hospital, Budapest, Hungary.
Eur J Cardiothorac Surg. 1988;2(6):416-24. doi: 10.1016/1010-7940(88)90044-9.
Experience with 2030 patients admitted for an actual episode of spontaneous pneumothorax, and with 370 patients hospitalized for bullous emphysema is thoroughly analyzed. Out of these groups, 400 patients (318 and 82 respectively) underwent an open thoracotomy. Macroscopic operative findings were divided into 8 groups. Descriptions of the aspect, size and site of bullae, respiratory function, mortality and follow-up data, are presented. Pathogenesis of the localised apical disease in comparison to the extended and diffuse types is outlined. Attention is drawn to the high operative risk in generalized emphysema and airway obstruction when associated with tension bullae and/or pneumothorax. More than 30% of the patients could not be included in either the juvenile type, isolated apical disease, or in the category of bullae associated with generalized emphysema. Reasons for an early rupture of apical subpleural blebs and the high resistance to check valve pressure of bullae following alveolar disruption are discussed. The observations lead to the conclusion that surgical pathology and treatment problems in bullous emphysema and in spontaneous pneumothorax have a lot in common and their arbitrary separation is not justified.
对2030例因自发性气胸实际发作而入院的患者以及370例因大疱性肺气肿住院的患者的经验进行了全面分析。在这些患者组中，400例患者（分别为318例和82例）接受了开胸手术。宏观手术结果分为8组。介绍了大疱的外观、大小和部位、呼吸功能、死亡率及随访数据。概述了局限性顶端疾病与广泛性和弥漫性类型相比的发病机制。当与张力性大疱和/或气胸相关时，应注意广泛性肺气肿和气道阻塞的高手术风险。超过30%的患者既不能归入青少年型、孤立性顶端疾病，也不能归入与广泛性肺气肿相关的大疱类别。讨论了顶端胸膜下疱早期破裂的原因以及肺泡破裂后大疱对单向阀压力的高抵抗力。这些观察结果得出结论，大疱性肺气肿和自发性气胸的手术病理和治疗问题有很多共同之处，将它们任意分开是不合理的。
