Fantin Alberto, Castaldo Nadia, Crisafulli Ernesto, Sartori Giulia, Aujayeb Avinash, Vailati Paolo, Morana Giuseppe, Patrucco Filippo, de Martino Maria, Isola Miriam, Patruno Vincenzo
Department of Pulmonology, Santa Maria della Misericordia University Hospital, Via Colugna, 33100, Udine, Italy.
Department of Medicine, Respiratory Medicine Unit, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
Pulm Ther. 2024 Sep;10(3):347-362. doi: 10.1007/s41030-024-00268-w. Epub 2024 Aug 10.
Medical thoracoscopy is a minimally invasive and safe procedure mostly performed for unexplained exudative pleural effusions but may be considered for pneumothorax (PNX).
This retrospective study included participants affected by PNX who underwent medical thoracoscopy with talc poudrage at a single academic hospital from 2008 to 2021. The primary endpoint was the observation of complete radiographical lung re-expansion and absence of air supply from the chest drain within 7 days of medical thoracoscopy. The secondary endpoint was achieving no recurrence of ipsilateral PNX at 24 months post-discharge.
A total of 95 patients affected by primary spontaneous PNX (PSP), secondary spontaneous PNX (SSP), iatrogenic, and traumatic PNX were enrolled. An additional procedure was required by 17.89% of patients, and only one patient with SSP required subsequent surgery. Recurrence of PNX occurred on the same side within 24 months after discharge in 9.47% of patients, with a median time to recurrence of 13.5 months. The PSP group was significantly more likely to achieve the primary endpoint. Pleural morphology was significantly associated with reaching the primary endpoint, while receiving a cumulative dose of talc greater than or equal to 4 g during hospitalization was associated with a lower risk of meeting it. Receiving a cumulative dose of talc greater than or equal to 4 g led in all cases to the achievement of the secondary endpoint. Patients with iatrogenic and traumatic PNX had an excellent prognosis in both the short- and long-term evaluation.
Medical thoracoscopy is an effective procedure for treating PNX in the acute setting in selected cases while preventing long-term relapses. Large prospective clinical studies are needed to support and better define the role of medical thoracoscopy in current clinical practice.
内科胸腔镜检查是一种微创且安全的手术，主要用于不明原因的渗出性胸腔积液，但气胸（PNX）患者也可考虑采用该方法。
这项回顾性研究纳入了2008年至2021年期间在一家学术医院接受滑石粉喷洒内科胸腔镜检查的PNX患者。主要终点是在内科胸腔镜检查后7天内观察到影像学上肺完全复张且胸腔引流管无气体引出。次要终点是出院后24个月同侧PNX无复发。
共纳入95例原发性自发性PNX（PSP）、继发性自发性PNX（SSP）、医源性和创伤性PNX患者。17.89%的患者需要额外的手术，只有1例SSP患者需要后续手术。9.47%的患者在出院后24个月内同侧PNX复发，复发的中位时间为13.5个月。PSP组更有可能达到主要终点。胸膜形态与达到主要终点显著相关，而住院期间接受累计剂量大于或等于4 g的滑石粉与达到该终点的风险较低相关。在所有病例中，接受累计剂量大于或等于4 g的滑石粉均导致达到次要终点。医源性和创伤性PNX患者在短期和长期评估中预后均良好。
内科胸腔镜检查是治疗特定病例急性气胸的有效方法，同时可预防长期复发。需要进行大型前瞻性临床研究来支持并更好地明确内科胸腔镜检查在当前临床实践中的作用。
