Department of Oncology, Immunology and Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan.
Department of Oncology, Immunology and Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
BMJ Open Respir Res. 2022 Apr;9(1). doi: 10.1136/bmjresp-2022-001231.
The postoperative recurrence rate after thoracoscopic bullectomy for primary spontaneous pneumothorax (PSP) is not satisfactory. This retrospective study was conducted to elucidate an effective technique for improving the postoperative recurrence rate.
The present study included 373 patients who underwent thoracoscopic bullectomy for PSP at three hospitals from January 2013 to May 2020. We compared the recurrence rate according to two methods that were used to cover the staple line after thoracoscopic bullectomy. Group A (146 patients) was treated with an absorbable polyglycolic acid (PGA) sheet plus fibrin glue and oxidised regenerated cellulose (ORC). Group B (227 patients) was treated with ORC alone.
There was no significant difference in preoperative characteristics of the patients. The postoperative recurrence rate of pneumothorax was 3.4% (5/146) in Group A and 17.2% (39/227) in Group B, respectively. Among 23 patients (Group A, n=3 and Group B, n=20) who received reoperation for recurrent pneumothorax, the site of recurrence was around the stapler line of the first operation in 1 of 5 (20%) patients in Group A and 28 of 39 (71.8%) patients in Group B. The 1-year recurrence-free rate was 97.4% (median follow-up period, 73 days (range, 2-3952 days)) in Group A and 80.9% (median follow-up period, 71 days (range 2-2648 days)) in Group B.
Coverage with a PGA sheet may prevent the postoperative recurrence of PSP. A large-scale prospective randomised study should be conducted to clarify the most effective treatment for PSP.
胸腔镜肺大疱切除术治疗原发性自发性气胸（PSP）的术后复发率并不理想。本回顾性研究旨在阐明一种提高术后复发率的有效技术。
本研究纳入了 2013 年 1 月至 2020 年 5 月在三家医院接受胸腔镜肺大疱切除术治疗 PSP 的 373 例患者。我们比较了两种方法覆盖胸腔镜肺大疱切除术后吻合线的复发率。A 组（146 例）采用可吸收聚乙二醇酸（PGA）片加纤维蛋白胶和氧化再生纤维素（ORC）治疗。B 组（227 例）仅用 ORC 治疗。
患者的术前特征无显著差异。A 组气胸术后复发率为 3.4%（5/146），B 组为 17.2%（39/227）。23 例（A 组 3 例，B 组 20 例）因气胸复发接受再次手术，A 组 5 例中有 1 例（20%）和 B 组 39 例中有 28 例（71.8%）复发部位位于第一次手术吻合器线附近。A 组 1 年无复发率为 97.4%（中位随访时间 73 天（范围 2-3952 天）），B 组为 80.9%（中位随访时间 71 天（范围 2-2648 天））。
PGA 片覆盖可能预防 PSP 的术后复发。应进行大规模前瞻性随机研究以明确 PSP 最有效的治疗方法。
