Campisi Alessio, Ciarrocchi Angelo Paolo, Grani Giorgio, Sanna Stefano, Congiu Stefano, Mazzarra Sara, Argnani Desideria, Salvi Maurizio, Stella Franco
Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, 34 Carlo Forlanini Street, 47121, Forlì, Italy.
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huai Hai Road, Shanghai, 200030, China.
Gen Thorac Cardiovasc Surg. 2022 Sep;70(9):818-824. doi: 10.1007/s11748-022-01802-w. Epub 2022 Mar 14.
Catamenial pneumothorax (CP) is defined as a recurrent, spontaneous pneumothorax occurring within a day before or 72 h after the onset of menstruation. Most first episodes go undiagnosed and treated as primary spontaneous pneumothorax, and only after recurrence is the clinical suspicion of CP raised. No gold-standard management approach exists, especially in terms of managing diaphragmatic involvement.
This study is a single-centre cohort retrospective study of 24 female patients who underwent surgery for pneumothorax due to diaphragmatic endometriosis between January 2008 and December 2016. Two groups were compared: a group that underwent pleurodesis alone (8 patients) and a group that underwent diaphragmatic surgery and pleurodesis (16 patients).
There were differences in BMI and smoking habits between the two groups. The right diaphragm was involved more often (6vs15, p = 0.190). VATS was the preferred surgical approach and only one conversion occurred in the diaphragmatic surgery group (p = 0.470). Diaphragmatic abnormalities were present in all the patients, brown/violet spots (100%) in the pleurodesis group and perforations (100%) in the diaphragmatic surgery group (p < 0.001). There were no differences in days of chest tube removal and length of stay. The recurrence rate was 100% in the pleurodesis alone group while it was only 12.5% in the diaphragmatic surgery group (< 0.001).
In our experience, diaphragmatic surgery and pleurodesis followed by hormonal therapy was an effective approach in preventing recurrence in patients with catamenial pneumothorax and diaphragmatic involvement.
经期气胸（CP）定义为在月经开始前一天内或月经开始后72小时内发生的复发性自发性气胸。大多数首次发作未被诊断出来，而是当作原发性自发性气胸进行治疗，只有在复发后才会引起对CP的临床怀疑。不存在金标准的管理方法，尤其是在处理膈肌受累方面。
本研究是一项单中心队列回顾性研究，研究对象为2008年1月至2016年12月间因膈肌子宫内膜异位症接受气胸手术的24例女性患者。比较了两组：单纯接受胸膜固定术的一组（8例患者）和接受膈肌手术及胸膜固定术的一组（16例患者）。
两组之间在体重指数和吸烟习惯方面存在差异。右侧膈肌受累更为常见（6例对15例，p = 0.190）。电视辅助胸腔镜手术（VATS）是首选的手术方法，膈肌手术组仅发生1例中转（p = 0.470）。所有患者均存在膈肌异常，胸膜固定术组有棕色/紫色斑点（100%），膈肌手术组有穿孔（100%）（p < 0.001）。胸腔引流管拔除天数和住院时间无差异。单纯胸膜固定术组的复发率为100%，而膈肌手术组仅为12.5%（< 0.001）。
根据我们的经验，膈肌手术及胸膜固定术联合激素治疗是预防经期气胸合并膈肌受累患者复发的有效方法。
