手动缝合非钉合式肺大疱切除术治疗青年男性原发性自发性气胸的评估

Evaluation of the nonstapling bullectomy by manual suturing for young men with primary spontaneous pneumothorax.

作者信息

Suzuki Kosuke, Kitami Akihiko, Komiyama Shinsaku, Okada Momoka, Takamiya Shinnosuke, Ohashi Shinichi, Uematsu Shugo

机构信息

Respiratory Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.

出版信息

J Thorac Dis. 2024 Sep 30;16(9):5826-5834. doi: 10.21037/jtd-24-693. Epub 2024 Sep 26.

DOI:10.21037/jtd-24-693

PMID:39444917

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11494564/

Abstract

BACKGROUND

Currently, surgery for primary spontaneous pneumothorax (PSP) is performed by bullectomy using a stapler with complete video-assisted thoracic surgery (cVATS). However, the postoperative recurrence rate (RR) of PSP is high in young men. The factors of postoperative PSP recurrence are the formation of postoperative bulla neogenesis (POBN) around the staple line, pleural injury caused by forceps for VATS, and bulla overlooked with a thoracoscope. We attempted nonstapling bullectomy with one-port-one-window (1p-1w) by using hybrid VATS (hVATS) to reduce postoperative RR. This study aimed to evaluate nonstapling bullectomy by manual suturing for young male patients with PSP compared with bullectomy by cVATS.

METHODS

From January 2012 to December 2022, we retrospectively reviewed the medical records of 259 male patients aged ≤25 years who underwent initial surgery for PSP and compared them between two groups, with staple use (S+) or by manual suturing without staple use (S-). RR, operative time, blood loss, and postoperative hospitalization period were examined in both groups.

RESULTS

The median operative time was 81 and 63 min in the S- and S+ groups, respectively (P<0.001), with the S- group tending to be statistically significantly longer. The mean intraoperative blood loss was 1.61 and 2.11 mL in the S- and S+ groups, respectively (P=0.003). The median postoperative hospitalization period was 4 days in both groups (P=0.32). Recurrences occurred in 8 (7.1%) and 14 patients (12.2%) in the S- and S+ groups, respectively [odds ratio (OR) =0.55; 95% confidence interval (CI): 0.22-1.37; P=0.19]. In patients aged <20 years, 5 (6.6%) and 10 (14.1%) patients had a recurrence in the S- and S+ groups, respectively (OR =0.42; 95% CI: 0.13-1.32; P=0.13).

CONCLUSIONS

Compared with stapling bullectomy, nonstapling bullectomy with small thoracotomy for young male patients with PSP had lesser RR. This procedure is beneficial in reducing postoperative recurrence and is one of the surgical choices for young male patients with PSP.

摘要

背景

目前，原发性自发性气胸（PSP）的手术是通过使用吻合器进行肺大疱切除术，并采用全胸腔镜手术（cVATS）。然而，年轻男性PSP的术后复发率（RR）较高。PSP术后复发的因素包括吻合器缝线周围术后新生肺大疱（POBN）的形成、胸腔镜手术用钳子造成的胸膜损伤以及胸腔镜遗漏的肺大疱。我们尝试通过使用杂交胸腔镜手术（hVATS）采用单孔单窗（1p-1w）非吻合器肺大疱切除术来降低术后RR。本研究旨在评估与cVATS肺大疱切除术相比，手动缝合非吻合器肺大疱切除术治疗年轻男性PSP患者的效果。

方法

回顾性分析2012年1月至2022年12月期间259例年龄≤25岁接受PSP初次手术的男性患者的病历，并将其分为两组进行比较，一组使用吻合器（S+），另一组采用不使用吻合器的手动缝合（S-）。对两组患者的RR、手术时间、失血量和术后住院时间进行检查。

结果

S-组和S+组的中位手术时间分别为81分钟和63分钟（P<0.001），S-组在统计学上明显更长。S-组和S+组的术中平均失血量分别为1.61毫升和2.11毫升（P=0.003）。两组的中位术后住院时间均为4天（P=0.32）。S-组和S+组分别有8例（7.1%）和14例（12.2%）患者复发[优势比（OR）=0.55；95%置信区间（CI）：0.22-1.37；P=0.19]。在年龄<20岁的患者中，S-组和S+组分别有5例（6.6%）和10例（14.1%）患者复发（OR =0.42；95% CI：0.13-1.32；P=0.13）。