Pediatric Pulmonology and National CF Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.
Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Clin Respir J. 2021 Sep;15(9):967-972. doi: 10.1111/crj.13400. Epub 2021 May 31.
Pneumothorax can be classified as traumatic, iatrogenic or spontaneous (SP), which can be subdivided into primary spontaneous pneumothorax (PSP), a condition without preexisting lung disease, or secondary spontaneous pneumothorax (SSP) a complication of a preexisting lung disease. Recurrence rate of PSP is 30% whereas for SSP rate is unknown. This article explores the experience of a tertiary center over 20 years.
A retrospective case review of patients hospitalized with pneumothorax to investigate the natural history and treatment of SP in a young population in a single tertiary center was conducted. A search of the digital archive (going back to 01/01/1995) of Sheba Medical Center identified hospitalized patients below the age of 40.
The database was composed of the records of 750 patients (612 males, 138 females) who were hospitalized. The recurrence risk for SP after nonoperative treatment was significantly higher. Women were found to have an increased risk of SSP when having SP (OR 2.78). Asthma was the most prevalent disease causing SSP in young people.
In this large cohort, we found that operative procedure has clear protective effect from recurrence in SP, so surgery should be positively considered when treating SP in hospitalized patients. Among young people and particularly in pediatric patients, when females have a SP, we strongly recommend looking for primary lung disease. More studies are needed to determine the risk factors and produce clear guidelines regarding surgery as first treatment.
气胸可分为外伤性、医源性和自发性（SP），可进一步分为无基础肺部疾病的原发性自发性气胸（PSP）或继发于基础肺部疾病的继发性自发性气胸（SSP）。PSP 的复发率为 30%，而 SSP 的复发率则未知。本文探讨了一家三级中心 20 多年来的经验。
对因气胸住院的患者进行回顾性病例回顾，以调查单一三级中心年轻人群中 SP 的自然病史和治疗情况。对 Sheba 医疗中心的数字档案（回溯至 1995 年 1 月 1 日）进行检索，以确定年龄在 40 岁以下的住院患者。
该数据库由 750 名（612 名男性，138 名女性）住院患者的记录组成。非手术治疗后 SP 的复发风险明显更高。患有 SP 的女性发生 SSP 的风险增加（OR 2.78）。哮喘是导致年轻人 SSP 的最常见疾病。
在这项大型队列研究中，我们发现手术对 SP 的复发有明确的保护作用，因此在治疗住院患者的 SP 时应积极考虑手术。在年轻人中，特别是在儿科患者中，当女性患有 SP 时，我们强烈建议寻找原发性肺部疾病。需要进一步研究以确定手术作为首选治疗的风险因素并制定明确的指南。
