Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, Setagaya-ku, Tokyo, Japan.
Department of Pathology, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan.
PLoS One. 2022 May 11;17(5):e0268299. doi: 10.1371/journal.pone.0268299. eCollection 2022.
Thoracic endometriosis-related pneumothorax is a secondary spontaneous pneumothorax caused by thoracic endometriosis. Diaphragmatic endometriosis is well-studied, but visceral and/or parietal pleural lesions are not. Although surgery is an effective treatment, postoperative recurrence rates are unsatisfactory probably due to inadequate understanding of underlying pathophysiology. We aimed to clarify the clinicopathological features of thoracic endometriosis.
In total, 160 patients who underwent thoracoscopic surgery from a single institution with histopathologically proven thoracic endometriosis from January 2015 to December 2019 were included. Clinicopathological characteristics and surgical outcomes were assessed retrospectively.
The cohort median age was 41 (range 22-53) years. Pneumothorax was right-sided in 159 (99.4%) and left-sided in only 1 (0.6%) case. Visceral and parietal pleural lesions were diagnosed in 79 (49.4%) and 71 (44.4%) patients, respectively. In total, 104 visceral pleural lesions and 101 parietal pleural lesions were detected. The S4 region and the dorsal 6th intercostal space contained the largest number of visceral pleural (66 lesions) and parietal pleural lesions (25 lesions), respectively. Histopathological evaluation revealed endometriotic tissues, existing in the outer external elastic layer in all lesions, were localized or invaded deeply. The median follow-up period was 370 (range, 6-1824) days. The Kaplan-Meier method revealed that the 1- and 2-year postoperative recurrence rates were 13.8% and 19.3%, respectively.
Visceral pleural endometriotic lesions may be disseminated from the visceral pleural surface and infiltrate into the pleura. Intraoperatively, careful observation of the specific sites, such as the visceral pleura of S4 and the parietal pleura of 6th intercostal space, is important to reduce postoperative recurrence.
胸腔子宫内膜异位症相关气胸是由胸腔子宫内膜异位症引起的继发性自发性气胸。膈部子宫内膜异位症研究较多，但内脏和/或壁层胸膜病变研究较少。尽管手术是一种有效的治疗方法，但术后复发率并不理想，可能是由于对潜在病理生理学的认识不足。我们旨在阐明胸腔子宫内膜异位症的临床病理特征。
本研究共纳入了 2015 年 1 月至 2019 年 12 月期间在一家单机构接受电视胸腔镜手术且经组织病理学证实为胸腔子宫内膜异位症的 160 例患者。回顾性评估了临床病理特征和手术结果。
该队列的中位年龄为 41 岁（范围 22-53 岁）。气胸右侧 159 例（99.4%），左侧 1 例（0.6%）。诊断为内脏和壁层胸膜病变的患者分别为 79 例（49.4%）和 71 例（44.4%）。共发现 104 个内脏胸膜病变和 101 个壁层胸膜病变。S4 区和第 6 肋背区分别包含最多的内脏胸膜病变（66 个）和壁层胸膜病变（25 个）。组织病理学评估显示，所有病变的外弹性层均存在子宫内膜异位组织，定位于或深部浸润。中位随访时间为 370 天（范围 6-1824 天）。Kaplan-Meier 法显示，术后 1 年和 2 年的复发率分别为 13.8%和 19.3%。
内脏胸膜子宫内膜异位症病变可能从内脏胸膜表面播散并浸润胸膜。术中仔细观察特定部位，如 S4 区的内脏胸膜和第 6 肋背区的壁层胸膜，对于降低术后复发率很重要。
