[Thoracoscopy in persistent or recurrent spontaneous pneumothorax].

To assess the value of thoracoscopy in spontaneous pneumothorax, the procedure and results of thoracoscopy by using fiberoptic bronchoscope and rigid cold-light thoracoscope in 50 patients with persistent or recurrent pneumothorax were reported. We found subpleural blebs or bullae in 35 cases and adhesions preventing lung expansion in 10 cases. The histologic diagnosis following thoracoscopic biopsy in 13 patients showed non-specific inflammation in 12 cases and tuberculosis in one case. The overall diagnostic rate was 92% (46/50). 5 cases were cured with transendoscopical Nd-YAG laser cauterisation of the blebs or bullae not exceeding 1 cm in diameter. There were no side effects after the procedure, and no recurrence was observed in a follow-up of 24 months. 40 patients were treated with intrapleural talcum power under thoracoscopic control. The postoperative complications were transient fever and chest pain and recurrence was observed in two cases only (5%) during 2-7 years of follow-up. It is concluded that thoracoscopy enables accurate assessment of the causes of pneumothorax, talc pleurodesis is a very effective method of controlling recurrent and persistent pneumothorax, and laser therapy can play an important role in selected patients with spontaneous pneumothorax.