Watanabe Takuya, Tanahashi Masayuki, Suzuki Eriko, Yoshii Naoko, Tsuchida Hiroyuki, Yobita Shogo, Iguchi Kensuke, Uchiyama Suiha, Nakamura Minori
Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
J Thorac Dis. 2022 May;14(5):1393-1400. doi: 10.21037/jtd-21-1851.
Secondary pneumothorax with interstitial lung disease (ILD) is often difficult to treat in comparison to primary pneumothorax. The purpose of this study was to analyze the actual management and outcome, and to find the most effective treatment.
Among 180 patients with pneumothorax caused by ILD, who were managed between January 2000 and April 2021, 129 patients were included. Fifty-one patients with observation only were excluded. In the present study, a patient was considered to be cured if their chest tube could be removed.
The managements included chest tube drainage alone (n=41), pleurodesis (n=67), bronchoscopic treatment (n=14), and surgery (include overlapping cases) (n=25). The mean number of pleurodesis treatments was 2.4 (range, 1-9), and the most frequently used agent was blood-patch. All patients who received bronchoscopic treatment underwent bronchial occlusion with silicon spigots. The surgical procedures included bullectomy (n=20), lung cyst ligation (n=3), pleural covering with oxidized cellulose sheet (n=1), and spraying of fibrin glue alone (n=1). One hundred patients (77.5%) were curatively treated, 27 patients (20.9%) died, and 2 patients were transferred without chest tube removal. Among 25 patients who received surgery [including 6 patients with performance status (PS) ≥2], 24 patients (96.0%) were cured, and 1 patient died due to an acute exacerbation of ILD after surgery. The univariate analysis revealed that PS ≥2 and >3 pleurodesis treatments were significant non-curative factors, while steroid treatment before the development of pneumothorax was not.
The outcomes of surgery for pneumothorax in patients with ILD were good, and it is desirable to consider the surgical indications.
与原发性气胸相比，间质性肺疾病（ILD）所致继发性气胸往往难以治疗。本研究旨在分析实际的治疗方法和结果，并找出最有效的治疗方法。
在2000年1月至2021年4月期间接受治疗的180例由ILD引起的气胸患者中，纳入了129例。排除仅接受观察的51例患者。在本研究中，如果患者的胸腔引流管可以拔除，则认为患者已治愈。
治疗方法包括单纯胸腔闭式引流（n = 41）、胸膜固定术（n = 67）、支气管镜治疗（n = 14）和手术（包括重叠病例）（n = 25）。胸膜固定术的平均治疗次数为2.4次（范围1 - 9次），最常用的药物是血液贴片。所有接受支气管镜治疗的患者均使用硅制栓子进行支气管封堵。手术操作包括肺大疱切除术（n = 20）、肺囊肿结扎术（n = 3）、用氧化纤维素片覆盖胸膜（n = 1）和单纯喷洒纤维蛋白胶（n = 1）。100例患者（77.5%）治愈，27例患者（20.9%）死亡，2例患者未拔除胸腔引流管即被转院。在接受手术的25例患者中[包括6例体能状态（PS）≥2的患者]，24例患者（96.0%）治愈，1例患者术后因ILD急性加重死亡。单因素分析显示，PS≥2和胸膜固定术治疗次数>3次是显著的非治愈因素，而气胸发生前的类固醇治疗不是。
ILD患者气胸的手术治疗效果良好，应考虑手术指征。
