Kobayashi Keisuke, Ichimura Hideo, Kawabata Shuntaro, Suzuki Hisashi, Endo Katsuyuki, Kobayashi Naohiro, Kikuchi Shinji, Goto Yukinobu, Sato Yukio
Department of Thoracic Surgery, Hitachi General Hospital, Ibaraki, Japan.
Department of Thoracic Surgery, University of Tsukuba, Ibaraki, Japan.
J Thorac Dis. 2023 Jul 31;15(7):3818-3828. doi: 10.21037/jtd-23-214. Epub 2023 Jul 17.
An optimal surgical procedure for primary spontaneous pneumothorax (PSP) has not yet been established. The study aimed to compare patient-reported outcomes (PROs) and clinical outcomes between parietal pleurectomy (pleurectomy) and visceral pleural covering with absorbable prosthesis (covering) added to thoracoscopic bullectomy in patients with PSP.
From January 2015 to April 2018, PROs were prospectively evaluated using EuroQOL-5 dimensions-5 levels (EQ5D). Questionnaires were administered preoperatively and at 1, 3, and 5 days and 1 month postoperatively. The perioperative outcomes were compared retrospectively. Recurrences and postoperative symptoms in the distant period were investigated cross-sectionally by telephone and mail surveys in February 2020.
In total, 26 and 29 patients underwent covering and pleurectomy, respectively. The visual analog scale score of the EQ5D on postoperative day 1 was significantly better in the pleurectomy group than in the covering group. There was no significant difference in the frequency of PROs in the EQ5D including pain. Perioperative outcomes, such as postoperative chest tube placement, and hospital stay, were comparable between the groups, except for the operative time. There was no significant difference in the recurrence rate and frequency of residual symptoms, e.g., chest discomfort in the long-term outcomes.
PROs and clinical outcomes were comparable between the two procedures. Further studies are required to determine the optimal treatment procedure.
原发性自发性气胸（PSP）的最佳手术方法尚未确立。本研究旨在比较PSP患者在胸腔镜下肺大疱切除术基础上，壁层胸膜切除术（胸膜切除术）与使用可吸收假体进行脏层胸膜覆盖术（覆盖术）的患者报告结局（PROs）和临床结局。
2015年1月至2018年4月，采用欧洲五维健康量表（EQ5D）对PROs进行前瞻性评估。术前及术后1天、3天、5天和1个月发放问卷。对围手术期结局进行回顾性比较。2020年2月通过电话和邮件调查对远期复发情况和术后症状进行横断面调查。
分别有26例和29例患者接受了覆盖术和胸膜切除术。胸膜切除术组术后第1天EQ5D的视觉模拟量表评分显著优于覆盖术组。在包括疼痛在内的EQ5D中，PROs的频率没有显著差异。除手术时间外，两组围手术期结局如术后胸管留置时间和住院时间相当。远期结局的复发率和残余症状（如胸部不适）频率无显著差异。
两种手术方法的PROs和临床结局相当。需要进一步研究以确定最佳治疗方法。
