Xu Rui, Wang Kaige, Shi Jingyu, Tian Panwen, Liu Dan
Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, 37 Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan Province, China.
Respir Res. 2025 Apr 25;26(1):162. doi: 10.1186/s12931-025-03255-0.
A significant proportion of patients with pneumothorax who do not tolerate surgery develop intractable pneumothorax after prolonged failure of conservative treatment. This significantly lengthens the duration of hospitalization and patients' quality of life. As the application of medical thoracoscopy (MT) in the management of pleural diseases is explored, MT combined with argon plasma coagulation (APC) may be an alternative option for the treatment of intractable pneumothorax.
A retrospective analysis was conducted on thirteen patients with intractable pneumothorax whose duration of the air leak exceeded seven days and subsequently treated with MT combined with APC at West China Hospital of Sichuan University. Under MT, we first dissected the pleural adhesions with an electrocautery knife, probed for the rupture located in the pulmonary bullae or pleural and cauterised it with APC. Subsequently, all pulmonary bullae were cauterised and human fibrin sealant was sprayed locally on the cauterised surface. Preoperative, intraoperative, and more than one year of postoperative follow-up information was collected from these patients. We divided the patients into two groups with and without detected ruptures treated under MT to compare the overall efficacy and safety of this treatment.
All patients had pulmonary comorbidities and the median duration of the current pneumothorax episode before MT treatment was 30 days. Nine patients had a history of recurrent pneumothorax episodes, two of whom had been treated with video-assisted thoracoscopic surgery (VATS). Regarding efficacy, the overall median time of time to air leak cessation was 2.5 days, with 2 days in the group with detected ruptures treated and 5 days in the group without detected ruptures treated, and the overall median time of time to chest tube removal was 6 days, with 4 days in the group with detected ruptures treated and 7 days in the group without detected ruptures treated. Regarding safety, only 2 patients experienced postoperative adverse events of fever and chest pain.
For intractable pneumothorax patients with pleural adhesions that may limit lung re-expansion, who are not candidates for surgery, MT combined with APC can be an alternative treatment option.
相当一部分不耐受手术的气胸患者在保守治疗长期失败后会发展为顽固性气胸。这显著延长了住院时间，降低了患者的生活质量。随着医学胸腔镜（MT）在胸膜疾病治疗中的应用不断探索，MT联合氩等离子体凝固（APC）可能是治疗顽固性气胸的一种替代选择。
对四川大学华西医院13例漏气时间超过7天且随后接受MT联合APC治疗的顽固性气胸患者进行回顾性分析。在MT下，我们首先用电灼刀分离胸膜粘连，探查位于肺大疱或胸膜的破裂口，并用APC烧灼。随后，烧灼所有肺大疱，并在烧灼表面局部喷洒人纤维蛋白封闭剂。收集这些患者术前、术中及术后一年以上的随访信息。我们将患者分为MT下检测到破裂口和未检测到破裂口的两组，以比较该治疗方法的总体疗效和安全性。
所有患者均有肺部合并症，MT治疗前本次气胸发作的中位持续时间为30天。9例患者有复发性气胸发作史，其中2例曾接受电视辅助胸腔镜手术（VATS）治疗。在疗效方面，漏气停止的总体中位时间为2.5天，检测到破裂口的治疗组为2天，未检测到破裂口的治疗组为5天；拔胸管的总体中位时间为6天，检测到破裂口的治疗组为4天，未检测到破裂口的治疗组为7天。在安全性方面，只有2例患者出现术后发热和胸痛等不良事件。
对于因胸膜粘连可能限制肺复张、不适合手术的顽固性气胸患者，MT联合APC可作为一种替代治疗选择。
