Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 80756, Taiwan.
Department of Surgery, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan.
BMC Pulm Med. 2021 Jul 3;21(1):210. doi: 10.1186/s12890-021-01577-5.
In adults with primary spontaneous pneumothorax (PSP), contralateral recurrence occurs in about 25-28% when there are asymptomatic blebs. How to treat contralateral recurrence of PSP in pediatric populations remains controversial. This study evaluated the outcomes of excising contralateral blebs to prevent recurrence in adolescents being operated on for PSP under the same anesthesia.
One hundred thirty-two male PSP patients under age 19 were surgically treated in a single institution between January 2008 and December 2016. Thoracoscopic blebectomies with pleurodesis were performed in all patients. The patients were categorized into those with contralateral blebs receiving one-stage bilateral surgeries (32 patients), those with contralateral blebs only receiving unilateral surgeries (40 patients), and those without contralateral blebs only receiving unilateral surgeries (60 patients). Perioperative details and outcomes were retrospectively analyzed.
Significant differences in contralateral recurrence rate were found among the three groups (0%, 30%, and 1%, respectively; P < 0.001). Multivariate analysis showed that being under 16.5 years old was a risk factor for overall recurrence (Hazard ratio [HR] 2.81, 95% confidence interval [CI] 1.08-7.30, P = 0.034). Moreover, patients who had contralateral blebs and only received unilateral surgery were at greater risk of overall recurrence (HR 6.06, 95% CI 1.77-20.75, P = 0.004). Kaplan-Meier analysis showed that contralateral and overall recurrence-free survival differed among the three groups (P < 0.0001, P = 0.0002).
Although younger male PSP adolescents treated with surgery were more likely to have postoperative recurrences, the performance of simultaneous contralateral blebectomies in those receiving one-stage bilateral surgeries significantly reduced future contralateral recurrence without compromising patient safety.
在原发性自发性气胸（PSP）成人患者中，当存在无症状大疱时，对侧复发率约为 25-28%。在儿科人群中如何治疗 PSP 的对侧复发仍存在争议。本研究评估了在同一麻醉下接受手术治疗 PSP 的青少年中切除对侧大疱以预防复发的效果。
2008 年 1 月至 2016 年 12 月，在一家机构中对 132 名年龄小于 19 岁的 PSP 男性患者进行了手术治疗。所有患者均行胸腔镜大疱切除术加胸膜固定术。将患者分为接受同期双侧手术的对侧大疱患者（32 例）、仅接受单侧手术的对侧大疱患者（40 例）和仅接受单侧手术的无对侧大疱患者（60 例）。回顾性分析围手术期细节和结果。
三组间对侧复发率差异有统计学意义（分别为 0%、30%和 1%；P<0.001）。多因素分析显示，年龄小于 16.5 岁是总体复发的危险因素（风险比 [HR] 2.81，95%置信区间 [CI] 1.08-7.30，P=0.034）。此外，仅接受单侧手术且有对侧大疱的患者总体复发风险更高（HR 6.06，95% CI 1.77-20.75，P=0.004）。Kaplan-Meier 分析显示，三组间对侧和总体无复发生存率不同（P<0.0001，P=0.0002）。
尽管接受手术治疗的年轻男性 PSP 青少年术后更有可能复发，但在接受同期双侧手术的患者中同时进行对侧大疱切除术可显著降低未来对侧复发率，而不会影响患者安全。
