Tribble C G, Selden R F, Rodgers B M
Ann Surg. 1986 Dec;204(6):677-80. doi: 10.1097/00000658-198612000-00010.
As patients with cystic fibrosis live longer, spontaneous pneumothoraces are seen with increasing frequency. Severe underlying pulmonary disease in these patients makes them particularly susceptible to life-threatening respiratory distress. Several modalities, including chemical sclerosis and open thoracotomy with pleurectomy, have been used to treat pneumothoraces in these patients. In the past 4 years, pneumothoraces in five patients (ages 9-22 years) with cystic fibrosis have been treated with thoracoscopy and talc poudrage. All procedures were performed under either regional or general anesthesia, depending on the age of the patient. Thoracoscopy was performed with a rod lens system and a 5.5-mm trocar, using biopsy forceps to lyse pleural adhesions, all of which ensures access to the entire pleural surface. United States Pharmacopeia-certified talc was insufflated to cover the entire pleural surface. There were no complications, and the patients had minimal pleural pain. Follow-up ranged from 6 months to 4 years. No patient has had a recurrent pneumothorax on the treated side. Thoracoscopy with talc poudrage is a preferable alternative to chemical sclerosis or thoracotomy for treating pneumothoraces in patients with cystic fibrosis. The procedure may be performed under regional anesthesia and allows rapid and complete sclerosis of the pleural cavity.
随着囊性纤维化患者寿命的延长，自发性气胸的发生率越来越高。这些患者严重的基础肺部疾病使他们特别容易出现危及生命的呼吸窘迫。包括化学硬化和开胸胸膜切除术在内的几种治疗方法已被用于治疗这些患者的气胸。在过去4年中，5例年龄在9至22岁之间的囊性纤维化患者的气胸采用胸腔镜滑石粉喷洒术进行治疗。所有手术均根据患者年龄在区域麻醉或全身麻醉下进行。使用棒状透镜系统和5.5毫米套管针进行胸腔镜检查，用活检钳溶解胸膜粘连，这一切确保了能触及整个胸膜表面。注入美国药典认证的滑石粉以覆盖整个胸膜表面。无并发症发生，患者胸膜疼痛轻微。随访时间为6个月至4年。治疗侧无患者出现复发性气胸。对于治疗囊性纤维化患者的气胸，胸腔镜滑石粉喷洒术是化学硬化或开胸手术的更好选择。该手术可在区域麻醉下进行，并能使胸腔迅速完全硬化。
