Tanaka F, Itoh M, Esaki H, Isobe J, Ueno Y, Inoue R
Department of Thoracic and Cardiovascular Surgery, National Gifu Hospital, Japan.
Ann Thorac Surg. 1993 Feb;55(2):372-6. doi: 10.1016/0003-4975(93)91001-4.
To assess the clinical manifestations and therapy of secondary spontaneous pneumothorax (SSP), 123 episodes of SSP in 67 patients were retrospectively reviewed and were compared with 254 episodes of primary spontaneous pneumothorax in 130 patients. The major underlying lung diseases associated with SSP were emphysema (22 patients) and tuberculosis (21 patients). The average age of patients with SSP was 66.8 years, and the most common symptom was dyspnea. The average arterial oxygen tension at onset of SSP was 61.1 +/- 12.1 mm Hg (mean +/- standard deviation), which was lower than that of patients with primary spontaneous pneumothorax (p < 0.01). The recurrence rate of open thoracotomy with pleural abrasion was 12.5% (3 of 24 episodes), which was not lower than that of thoracostomy tube drainage with chemical pleurodesis using tetracycline (recurrence rate, 18.8%) (p > 0.5). We concluded that considering the high age of the patients, the presence of underlying lung diseases, and the increased operative risk, thoracostomy tube drainage rather than open thoracotomy was preferred as the first choice of therapy for SSP.
为评估继发性自发性气胸（SSP）的临床表现及治疗方法，我们回顾性分析了67例患者的123次SSP发作情况，并与130例患者的254次原发性自发性气胸发作情况进行比较。与SSP相关的主要基础肺部疾病为肺气肿（22例）和肺结核（21例）。SSP患者的平均年龄为66.8岁，最常见症状为呼吸困难。SSP发作时的平均动脉血氧分压为61.1±12.1 mmHg（均值±标准差），低于原发性自发性气胸患者（p<0.01）。开胸胸膜摩擦术的复发率为12.5%（24次发作中有3次），不低于使用四环素进行化学性胸膜固定术的胸腔闭式引流术（复发率为18.8%）（p>0.5）。我们得出结论，考虑到患者年龄较大、存在基础肺部疾病以及手术风险增加，胸腔闭式引流术而非开胸手术应作为SSP治疗的首选方法。
