Yim A P, Liu H P
Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
Surg Laparosc Endosc. 1997 Jun;7(3):236-40.
Although Video-Assisted Thoracoscopic Surgery (VATS) is now accepted by many as the approach of choice in the management of primary spontaneous pneumothorax (PSP), the optimal procedure and the timing of surgical intervention remain areas of contention. The authors reviewed their combined experience with 518 consecutive VATS procedures for PSP in 483 patients. Mechanical pleurodesis was performed in every case and was the only procedure in 20 patients. We had experience with several means of eliminating subpleural bullae once identified: stapled bullectomy (196), endoloop (261), argon beam coagulation (6) and endoscopic suturing (35). There were no mortality or intraoperative complications. Median postoperative hospital stay was 3 days. So far, we have had 9 recurrences (1.74%), after a mean follow up of 20 months (range one to 36 months). Complications consisted of 18 persistent air leaks, 14 would infections and 1 chest wall bleeding. We conclude that (1) VATS is a safe and effective approach in the treatment of PSP; (2) Stapled-bullectomy is quick and reliable but costly; (3) Endoloop and suturing are viable alternative techniques that may prove to be more cost effective; (4) we do not recommend to use argon beam coagulation as the primary treatment modality.
尽管电视辅助胸腔镜手术（VATS）如今已被许多人视为原发性自发性气胸（PSP）治疗的首选方法，但最佳手术方式和手术干预时机仍存在争议。作者回顾了他们对483例患者连续进行518例VATS治疗PSP的综合经验。每例均进行了机械胸膜固定术，其中20例仅采用了该手术。我们有多种识别后消除胸膜下肺大疱的方法的经验：吻合器肺大疱切除术（196例）、圈套器（261例）、氩气刀凝固（6例）和内镜缝合（35例）。无死亡病例或术中并发症。术后中位住院时间为3天。到目前为止，平均随访20个月（范围1至36个月）后，我们有9例复发（1.74%）。并发症包括18例持续性气胸、14例伤口感染和1例胸壁出血。我们得出结论：（1）VATS是治疗PSP的一种安全有效的方法；（2）吻合器肺大疱切除术快速可靠但成本高；（3）圈套器和缝合是可行的替代技术，可能更具成本效益；（4）我们不建议将氩气刀凝固作为主要治疗方式。
