Yang Jun Tae, Kim Sahri, Kim Hyoung Soo, Lee Hee Sung, Ra Yong Joon, Lee Hong Kyu
Department of Thoracic and Cardiovascular Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea.
Department of Thoracic and Cardiovascular Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.
J Chest Surg. 2023 Jul 5;56(4):240-243. doi: 10.5090/jcs.23.006. Epub 2023 Apr 25.
Although there is no obvious recommendation for the management of pneumothorax recurrence after surgery, chemical pleurodesis with tetracycline has been applied as a significant treatment approach. The objective of this study was to evaluate the effectiveness of chemical pleurodesis with tetracycline for the management of postoperative recurrence of primary spontaneous pneumothorax (PSP).
We retrospectively analyzed patients who underwent video-assisted thoracic surgery (VATS) as therapy for PSP at Hallym University Sacred Heart Hospital from January 2010 to December 2016. Patients who had ipsilateral recurrence after surgery were included in this study. Patients who underwent pleural drainage with chemical pleurodesis were compared with patients who only underwent pleural drainage.
In total, 932 patients who underwent VATS for PSP were analyzed, and ipsilateral recurrence after surgery occurred in 67 patients (7.1%). The treatment modalities for recurrence after surgery were observation (n=12), pleural drainage alone (n=16), pleural drainage with chemical pleurodesis (n=34), and repeated VATS (n=5). Eight of the 16 patients (50 %) treated with pleural drainage alone had recurrence again, while 15 of the 34 patients (44.1%) treated with pleural drainage and chemical pleurodesis experienced further recurrence. Chemical pleurodesis with tetracycline did not show a meaningful difference in the re-recurrence rate in comparison with pleural drainage alone (p=0.332).
Chemical pleurodesis with tetracycline for the management of postoperative recurrence of PSP was not effective. Further research is required to identify alternative drugs that can significantly decrease the re-recurrence rate.
虽然对于手术后气胸复发的处理尚无明确的推荐方法，但四环素化学性胸膜固定术已被用作一种重要的治疗手段。本研究的目的是评估四环素化学性胸膜固定术治疗原发性自发性气胸（PSP）术后复发的有效性。
我们回顾性分析了2010年1月至2016年12月在韩林大学圣心医院接受电视辅助胸腔镜手术（VATS）治疗PSP的患者。本研究纳入了术后同侧复发的患者。将接受胸膜腔引流加化学性胸膜固定术的患者与仅接受胸膜腔引流的患者进行比较。
总共分析了932例接受VATS治疗PSP的患者，术后同侧复发的有67例（7.1%）。术后复发的治疗方式包括观察（n = 12）、单纯胸膜腔引流（n = 16）、胸膜腔引流加化学性胸膜固定术（n = 34）和重复VATS（n = 5）。单纯胸膜腔引流治疗的16例患者中有8例（50%）再次复发，而胸膜腔引流加化学性胸膜固定术治疗的34例患者中有15例（44.1%）再次复发。与单纯胸膜腔引流相比，四环素化学性胸膜固定术在再次复发率方面没有显著差异（p = 0.332）。
四环素化学性胸膜固定术治疗PSP术后复发无效。需要进一步研究以确定能显著降低再次复发率的替代药物。
