Magnadottir Thordis, Heitmann Leon Arnar, Arnardottir Tinna Harper, Kristjansson Tomas Thor, Silverborn Per Martin, Sigurdsson Martin Ingi, Gudbjartsson Tomas
Departments of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland.
Faculty of Medicine, University of Iceland.
Laeknabladid. 2022 Jun;108(6):299-305. doi: 10.17992/lbl.2022.06.696.
Primary spontaneous pneumothorax (PSP) is a common disease where surgery is indicated for persistant air leak or recurrent pneumothorax. We studied the outcomes of PSP-surgery over a 28 year period in a whole nation.
A retrospective study on 386 patients (median age 24 years, 78% males) that underwent 430 PSP surgeries at Landspitali University Hospital 1991-2018. Annual incidence of the procedure was calculated and previous medical history, indication and type of surgery, complications and length of hospital stay were registered. Patients in four 7 year periods were compared, recurrent pneumothoraces requiring reoperation (median follow-up 16 years) registered and predictors of reoperation identified with logistic regression.
Annually 14.5 PSP surgeries (median, range 9-27) were performed; the incidence decreasing by 2.9% per year on average. Every other patient smoked and 77% of surgeries were performed with video assisted thoracocopic surgery (VATS). The most common early complications (p<30 days from surgery) were persistent airleak (17%), pneumonia (2%) and empyema (0,5%). No patient died within 30 days from surgery. Reoperation for recurrent pneumothorax was performed on 27 patients; 24 following VATS (7%), median time from the primary surgery being 16 months. Logistic regression showed that younger patients were more likely to require reoperation for recurrent pneumothorax.
Surgical treament for PSP is safe and major early complications rare. The rate of recurrent pneumothorax requiring surgery was 6%, which is similar to other studies. For unknown reasons the incidence of PSP surgery declined, but future research has to answer if it is linked to decreased smoking in the Icelandic population.
原发性自发性气胸（PSP）是一种常见疾病，对于持续性漏气或复发性气胸患者需进行手术治疗。我们对全国范围内28年间PSP手术的结果进行了研究。
对1991年至2018年在冰岛国家大学医院接受430例PSP手术的386例患者（中位年龄24岁，78%为男性）进行回顾性研究。计算该手术的年发病率，并记录既往病史、手术指征和类型、并发症及住院时间。对四个7年时间段内的患者进行比较，记录需要再次手术的复发性气胸患者（中位随访16年），并通过逻辑回归确定再次手术的预测因素。
每年进行14.5例PSP手术（中位值，范围9 - 27例）；发病率平均每年下降2.9%。每例患者中半数吸烟，77%的手术采用电视辅助胸腔镜手术（VATS）。最常见的早期并发症（术后<30天）为持续性漏气（17%）、肺炎（2%）和脓胸（0.5%）。术后30天内无患者死亡。27例患者因复发性气胸接受再次手术；24例在VATS术后（7%），距初次手术的中位时间为16个月。逻辑回归显示，年轻患者更有可能因复发性气胸而需要再次手术。
PSP的手术治疗安全，早期主要并发症罕见。需要手术治疗的复发性气胸发生率为6%，与其他研究相似。由于未知原因，PSP手术的发病率下降，但未来研究需明确其是否与冰岛人群吸烟率下降有关。
