Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
ANZ J Surg. 2024 Oct;94(10):1776-1780. doi: 10.1111/ans.19170. Epub 2024 Jul 26.
Primary spontaneous pneumothorax occurs in patients with no underlying lung disease and guidelines recommend chest tube drainage for the first episode, with surgical intervention reserved for recurrent episodes, persistent air leak or failure of lung re-expansion. Modern surgical management is associated with reduced length of hospital stay and superior freedom from recurrence compared with chest tube drainage alone. The objective of this study was to identify risk factors for failed chest tube drainage in patients who present with first episode primary spontaneous pneumothorax.
A retrospective analysis of patients who presented to Royal Prince Alfred Hospital, Australia with first episode PSP and underwent chest tube insertion was performed. Patient demographics and size of pneumothorax were examined in relation to the primary outcome, a composite of failed chest tube drainage and recurrent ipsilateral pneumothorax.
Fifty-five patients underwent chest tube drainage for first episode primary spontaneous pneumothorax between 1st January 2017 and 31st December 2020. Complete lung collapse on admission chest x-ray was associated with an increased risk of the primary outcome (63% versus 19%, OR 7.3 [96% CI 2.0-27.4), P = 0.004).
This small retrospective study found that patients that undergo chest drain insertion for first episode primary spontaneous pneumothorax who present with complete lung collapse on admission are at high risk of requiring pleurodesis and therefore may benefit from early surgical referral.
原发性自发性气胸发生于无基础肺部疾病的患者，指南建议对首次发作采用胸腔引流管治疗，对反复发作、持续漏气或肺复张失败保留手术干预。与单纯胸腔引流管相比，现代手术管理与缩短住院时间和降低复发率相关。本研究旨在确定首次发作原发性自发性气胸患者行胸腔引流管治疗失败的风险因素。
对 2017 年 1 月 1 日至 2020 年 12 月 31 日在澳大利亚皇家阿尔弗雷德王子医院就诊的首次发作 PSP 并接受胸腔引流管插入术的患者进行回顾性分析。研究人员检查了患者的人口统计学特征和气胸大小与主要结局（胸腔引流管治疗失败和同侧气胸复发的复合结局）之间的关系。
55 例患者因首次发作原发性自发性气胸接受胸腔引流管治疗。入院时胸部 X 线显示完全肺萎陷与主要结局风险增加相关（63%与 19%，OR 7.3 [96%CI 2.0-27.4]，P=0.004）。
本小型回顾性研究发现，首次发作原发性自发性气胸患者接受胸腔引流管治疗，入院时完全肺萎陷的患者发生需要胸膜固定术的风险较高，因此可能受益于早期手术转诊。
