Kitamura Naoya, Takahashi Tomohiko, Kawamukai Jun, Shinno Hideki, Tsuchiya Tomoshi
Thoracic Surgery, Toyama University Hospital, Toyama, JPN.
General Thoracic Surgery, Toyama Prefectural Central Hospital, Toyama, JPN.
Cureus. 2024 Feb 22;16(2):e54718. doi: 10.7759/cureus.54718. eCollection 2024 Feb.
Although the usefulness of thoracoscopic surgery under local anesthesia for pneumothorax has been reported, there are some cases of failure. Therefore, it is important to share the various techniques and potential challenges associated with procedures performed under local anesthesia. A 79-year-old male, under monitoring for a left chronic pneumothorax, was newly diagnosed with a right pneumothorax. Chest computed tomography taken after thoracic drainage showed a poorly expanded right lung with severe adhesions and multiple bullae in the right lung, in addition to identifying a left pneumothorax. Although significant air leakage persisted, general anesthesia was deemed unsuitable, necessitating thoracoscopic surgery under local anesthesia. A fistula of approximately 1 × 1 cm was identified on the bulla wall, which was closed with 4-0 Prolene®sutures (Johnson&Johnson, New Jersey, United States), each reinforced with pledgets and covered with a polyglycolic acid sheet and fibrin glue. The patient was discharged on postoperative day six and no recurrence of pneumothorax was noted after discharge. Direct suture closure of the bulla wall under local anesthesia can be an alternative technique for the treatment of pneumothorax caused by large bulla collapse in patients at high risk for general anesthesia.
尽管已有报道称局部麻醉下的胸腔镜手术治疗气胸有用，但仍有一些失败病例。因此，分享局部麻醉下手术的各种技术及潜在挑战很重要。一名79岁男性，因左慢性气胸接受监测，新诊断出右气胸。胸腔引流后进行的胸部计算机断层扫描显示右肺膨胀不良，伴有严重粘连和右肺多发肺大疱，此外还发现了左气胸。尽管仍有大量漏气，但全身麻醉被认为不合适，因此需要在局部麻醉下进行胸腔镜手术。在肺大疱壁上发现一个约1×1厘米的瘘管，用4-0普理灵缝线（美国新泽西州强生公司生产）进行缝合，每针均用棉垫加强，并用聚乙醇酸片和纤维蛋白胶覆盖。患者术后第6天出院，出院后未发现气胸复发。对于全身麻醉高风险患者，局部麻醉下直接缝合肺大疱壁可作为治疗由大疱破裂引起的气胸的替代技术。
