Milanez J R, Vargas F S, Filomeno L T, Fernandez A, Jatene A, Light R W
Hospital das Clinicas, University of Sao Paulo, Brazil.
Chest. 1994 Oct;106(4):1162-5. doi: 10.1378/chest.106.4.1162.
The ipsilateral recurrence rate after the first spontaneous pneumothorax treated with tube thoracostomy is reported to be between 23 percent and 52 percent. The incidence of recurrence after the first recurrence is substantially higher. Chemical pleurodesis has been attempted to decrease the recurrence rate. Tetracycline has been widely utilized, but parenteral tetracycline is no longer available. Therefore, alternative sclerosing agents have been used. Talc has been demonstrated to be effective in preventing recurrences and it has minimal long-term effects. This prospective study was designed to determine the efficacy of talc pleurodesis in patients with recurrent spontaneous pneumothorax. Eighteen patients admitted between May 1985 and March 1993 to the Department of Thoracic Surgery underwent thoracoscopy and were treated by tube thoracostomy with chemical pleurodesis. All the patients had had at least two pneumothoraces and six had had at least six pneumothoraces. Sterile asbestos-free talc, 2g, was aerosolized throughout the pleural surface. One or two chest tubes were inserted, left clamped for 2 h, and unclamped after this time. The tubes were removed when no air had escaped for 24 h. Only one (5.6 percent) patient had recurrence of the pneumothorax, and a second insufflation of talc resulted in no new recurrence after a follow-up of 10 months. The remaining 94.4 percent did not have recurrence of pneumothorax within an observation period of 38.5 +/- 28.1 months. The follow-up was more than 2 years for 66.7 percent with no recurrence and was more than 5 years for 33.3 percent. We conclude from these observations that the insufflation of 2 g of talc into the pleural space is a safe effective treatment for control of recurrent spontaneous pneumothorax.
据报道，首次自发性气胸经胸腔闭式引流治疗后的同侧复发率在23%至52%之间。首次复发后的复发率则显著更高。人们尝试采用化学性胸膜固定术来降低复发率。四环素曾被广泛使用，但注射用四环素已不再可得。因此，人们开始使用其他硬化剂。滑石粉已被证明在预防复发方面有效，且长期影响极小。这项前瞻性研究旨在确定滑石粉胸膜固定术对复发性自发性气胸患者的疗效。1985年5月至1993年3月间，18名入住胸外科的患者接受了胸腔镜检查，并通过胸腔闭式引流及化学性胸膜固定术进行治疗。所有患者均至少发生过两次气胸，其中6名患者至少发生过6次气胸。将2克无菌无石棉滑石粉雾化后喷洒在整个胸膜表面。插入一或两根胸管，夹闭2小时，之后放开。当24小时无气体逸出时拔除胸管。仅1名患者（5.6%）气胸复发，再次注入滑石粉后，随访10个月未出现新的复发。其余94.4%的患者在38.5±28.1个月的观察期内未出现气胸复发。66.7%的患者随访超过2年无复发，33.3%的患者随访超过5年无复发。我们从这些观察结果得出结论，向胸膜腔内注入2克滑石粉是控制复发性自发性气胸的一种安全有效的治疗方法。
