Krasnik M, Stimpel H, Halkier E
Department of Thoracic and Cardiovascular Surgery, Bispebjerg Hospital, Hellerup, Denmark.
Scand J Thorac Cardiovasc Surg. 1993;27(1):49-51. doi: 10.3109/14017439309099093.
Spontaneous pneumothorax has a high incidence of recurrence if treated only with intercostal drainage. A series of 404 patients in a special treatment program is presented. Early thoracoscopy was performed in 97%. The 86 patients (21%) then found to have true cyst (> 2 cm) were subjected to thoracotomy with removal of cyst and mechanical pleurodesis, and in the others a dilute tetracycline solution was instilled intrapleurally, followed by intercostal tube drainage. There was no recurrence of pneumothorax in the group treated with thoracotomy, but 8% recurrence in the tetracycline-treated group. Repeated thoracoscopy was performed in 21 of the 25 patients with recurrent pneumothorax, and thoracotomy with resection of large cyst in four. The probable cause of recurrence was identified in 21 cases, making the true recurrence rate 1% (4 patients). The mean hospital stay was 7.6 days for the patients with thoracotomy and 4.3 days for the tetracycline-treated group.
单纯采用肋间引流治疗自发性气胸时复发率很高。本文报告了纳入一项特殊治疗方案的404例患者的情况。97%的患者接受了早期胸腔镜检查。随后发现86例（21%）患者存在真正的囊肿（>2 cm），这些患者接受了开胸手术，切除囊肿并进行机械性胸膜固定术，其他患者则经胸腔内注入稀释的四环素溶液，随后进行肋间置管引流。接受开胸手术治疗的组中气胸未复发，但四环素治疗组的复发率为8%。25例复发性气胸患者中有21例接受了重复胸腔镜检查，4例接受了开胸手术切除大囊肿。21例患者确定了复发的可能原因，使真正的复发率为1%（4例患者）。开胸手术患者的平均住院时间为7.6天，四环素治疗组为4.3天。
