Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA.
Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA.
J Laparoendosc Adv Surg Tech A. 2021 Dec;31(12):1424-1430. doi: 10.1089/lap.2021.0335. Epub 2021 Nov 5.
Video-assisted thoracoscopic surgery (VATS) with pulmonary apical wedge resection is the mainstay procedure performed for spontaneous pneumothorax (sPTX). However, there is variability in adjunctive techniques, including pleurectomy or mechanical pleurodesis, used to prevent recurrences. The objectives of this study were to determine sPTX recurrence rates after initial VATS and to compare the efficacy of adjunct pleurectomy versus mechanical pleurodesis. Patients 11-21 years old who experienced sPTX and underwent initial VATS from December 2011 to December 2020 were identified at a single institution. Descriptive analyses and statistical tests were performed to identify factors associated with ipsilateral sPTX recurrence after surgery. Fifty-six patients (48 males) underwent 58 VATS. The majority of patients were white (82.1%), male (85.7%), and nonsmokers (78.6%). Pleurectomy was performed in 27 (46.5%) cases, mechanical pleurodesis in 25 (43.1%), and pleurectomy with mechanical pleurodesis in 6 (10.3%). Overall, 15 patients (25.9%) experienced a postoperative recurrence, of which 8 (13.8%) required intervention. Recurrences occurred between 7 and 800 days after the index procedure. There was no significant difference in rates of overall recurrence between pleurectomy, mechanical pleurodesis, and pleurectomy with mechanical pleurodesis [7/27 (25.9%); 7/25 (28.0%); 1/6 (16.7%): = .99] or recurrences requiring intervention between the three adjunctive techniques (5/27; 3/25; 0/6: = .66). Over 25% of patients experience recurrence of sPTX after VATS. Recurrence rates were similar whether pleurectomy, mechanical pleurodesis, or pleurectomy with pleurodesis was performed. Further multi-institutional and prospective studies are needed to establish the optimal strategy to limit recurrence rates for pediatric patients with sPTX.
电视辅助胸腔镜手术（VATS）联合肺尖楔形切除术是治疗自发性气胸（sPTX）的主要方法。然而，在预防复发的辅助技术方面存在差异，包括胸膜切除术或机械性胸膜固定术。本研究的目的是确定初次 VATS 后 sPTX 的复发率，并比较胸膜切除术与机械性胸膜固定术的疗效。在一家机构中，确定了 2011 年 12 月至 2020 年 12 月期间经历 sPTX 并接受初次 VATS 的 11-21 岁患者。通过描述性分析和统计检验确定与手术后同侧 sPTX 复发相关的因素。56 例患者（48 名男性）接受了 58 例 VATS。大多数患者为白人（82.1%）、男性（85.7%）和不吸烟者（78.6%）。27 例（46.5%）患者行胸膜切除术，25 例（43.1%）行机械性胸膜固定术，6 例（10.3%）行胸膜切除术联合机械性胸膜固定术。总体而言，15 例（25.9%）患者术后复发，其中 8 例（13.8%）需要干预。复发发生在指数手术后 7 至 800 天之间。胸膜切除术、机械性胸膜固定术和胸膜切除术联合机械性胸膜固定术的总复发率之间没有显著差异[27 例中的 7 例（25.9%）；25 例中的 7 例（28.0%）；6 例中的 1 例（16.7%）： = .99]，或三种辅助技术中需要干预的复发之间也没有显著差异（27 例中的 5 例；25 例中的 3 例；6 例中的 0 例： = .66）。超过 25%的患者在 VATS 后经历 sPTX 复发。行胸膜切除术、机械性胸膜固定术或胸膜切除术联合胸膜固定术时，复发率相似。需要进一步的多机构和前瞻性研究来确定限制 sPTX 患儿复发率的最佳策略。
