Department of Cardiothoracic Surgery, Guangzhou Panyu Central Hospital, Guangdong, 511400, People's Republic of China.
Information Statistics Center, Guangzhou Panyu Central Hospital, Guangdong, 511400, People's Republic of China.
Gen Thorac Cardiovasc Surg. 2021 Nov;69(11):1492-1498. doi: 10.1007/s11748-021-01663-9. Epub 2021 Jun 7.
Controversy exists regarding the justification of primary surgery in primary spontaneous pneumothorax, and surgery is not free from recurrence. We hypothesized that surgery is a risk factor for contralateral recurrence pneumothorax in adolescent.
We performed a retrospective cohort study of 163 adolescent with pneumothorax who were treated conservatively with chest tube (n = 100) or chest tube followed by video-assisted thoracoscopic surgery (n = 63) from January 2009 through December 2017.
Ipsilateral recurrence was significantly more common following conservative treatment than surgical treatment (25.0 vs. 3.2%, P < 0.001), while contralateral recurrence was more common in the surgical group than in the conservative group (15.9 vs. 6.0%, P = 0.039). The rates of second episode pneumothorax did not significantly differ between the two treatment groups (P = 0.092). Univariate analysis identified that patients who were treated conservatively had greater risk of ipsilateral recurrence (P = 0.002), while those who proceeded to surgery had greater risk of contralateral recurrence (P = 0.046). No predictors for second episode pneumothorax were found.
To avoid over treatment, we recommend that conservative treatment should be the superior option and CT scan should not be a routine examination in adolescent with their first episode of PSP.
对于原发性自发性气胸是否需要进行初次手术存在争议，且手术并不能完全避免复发。我们假设手术是青少年发生对侧气胸复发的一个危险因素。
我们进行了一项回顾性队列研究，纳入了 2009 年 1 月至 2017 年 12 月期间接受保守治疗（胸腔引流管治疗，n=100）或胸腔引流管治疗后行电视辅助胸腔镜手术（n=63）的 163 例青少年气胸患者。
与手术治疗相比，保守治疗后同侧复发更为常见（25.0%比 3.2%，P<0.001），而手术组的对侧复发更为常见（15.9%比 6.0%，P=0.039）。两组间第二次气胸发作的发生率无显著差异（P=0.092）。单因素分析显示，接受保守治疗的患者同侧复发风险更高（P=0.002），而行手术治疗的患者对侧复发风险更高（P=0.046）。未发现预测第二次气胸发作的因素。
为避免过度治疗，我们建议保守治疗应为首选，且青少年初次发作 PSP 时，CT 扫描不应作为常规检查。
