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[持续性或复发性气胸的外科治疗结果]

[Results of surgical treatment of persistent or recurrent pneumothorax].

作者信息

Thomas P, Le Mee F, Le Hors H, Sielezneff I, Auge A, Giudicelli R, Fuentes P

机构信息

Service de Chirurgie Thoracique et des Maladies de l'Oesophage, Hôpital Sainte Marguerite, Marseille.

出版信息

Ann Chir. 1993;47(2):136-40.

PMID:8317871
Abstract

From 1st January 1988 to 31st December 1991, 107 patients were operated on for spontaneous idiopathic (N = 69) or secondary pneumothorax (N = 38). Surgery was performed for recurrence (63.6%) or failure to respond to management by tube drainage (36.4%). Ninety seven patients underwent pleural abrasion, and 10 underwent parietal pleurectomy. Prolonged continuous epidural analgesia was performed in 57 cases. Postoperative complications occurred in 15 patients (14%). Overall morbidity was significantly higher in patients with chronic lung disease (26.3%) than in patients without chronic lung disease (7.2%) (p < or = 0.01). As far as postoperative hospital stay was concerned, the same significant difference was observed (16.8 days versus 12.7 days) (p < or = 0.005). In patients with idiopathic pneumothorax, postoperative hospital stay was significantly shorter in those with epidural pain relief (11.7 days) than in the others (13.6 days) (p < or = 0.025). No recurrence was observed with a mean follow-up of 27 months. We conclude that: 1) surgery is the most efficient treatment of persistent or recurrent pneumothorax; 2) operative morbidity is related to the underlying lung disease and not to the procedure itself; 3) epidural analgesia is beneficial in this surgery.

摘要

1988年1月1日至1991年12月31日期间,107例患者接受了自发性特发性气胸(69例)或继发性气胸(38例)的手术治疗。手术原因是复发(63.6%)或胸腔闭式引流治疗无效(36.4%)。97例患者接受了胸膜摩擦术,10例接受了壁层胸膜切除术。57例患者进行了长时间持续硬膜外镇痛。15例患者(14%)出现术后并发症。慢性肺部疾病患者的总体发病率(26.3%)显著高于无慢性肺部疾病患者(7.2%)(p≤0.01)。就术后住院时间而言,也观察到了同样显著的差异(16.8天对12.7天)(p≤0.005)。在特发性气胸患者中,接受硬膜外镇痛的患者术后住院时间(11.7天)明显短于未接受硬膜外镇痛的患者(13.6天)(p≤0.025)。平均随访27个月未观察到复发。我们得出以下结论:1)手术是治疗持续性或复发性气胸最有效的方法;2)手术发病率与潜在的肺部疾病有关,而与手术本身无关;3)硬膜外镇痛在该手术中有益。

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