Passlick B, Born C, Thetter O
Abteilung für Thoraxchirurgie, Zentralkrankenhaus Gauting.
Pneumologie. 1997 Dec;51(12):1135-9.
The objective of the study was to analyse the efficiency of video-assisted thoracic surgery (VATS) in the treatment of primary spontaneous pneumothorax (PSP) in an initial series of 65 patients.
From April 1992 to December 1995 47 male and 18 female patients with a median age of 28 years (range 17-53) were treated for persistent (n = 20) or recurrent (n = 45) spontaneous pneumothorax by VATS. In most patients a stapling of bullae using an endostapler was performed followed by parietal pleurectomy or pleural abrasion. Postoperative parameters, like use of analgetics, length of hospital stay and length of drainage were compared with a control group of 57 patients treated by lateral thoracotomy between January 1988 and December 1991.
Conversion to lateral thoracotomy was necessary in 6 (9.3%) patients. Postoperative complications occurred in one patient (1.7%) consisting of a persistent air leak for more than 7 days. No second intervention was necessary. There were no operative deaths. 4 recurrences were noted after a median follow-up of 29 months. All recurrences occurred in the first 18 months after surgery. Compared to lateral thoracotomy the treatment by VATS resulted in a significantly shortened hospital stay (mean: 8 vs. 11 days; p < 0.001) and drainage time (mean: 4 vs. 5 days; p < 0.001). The use of opioid analgetics was 3.7 days (mean, range 1-11 days) after VATS and 6.5 days (mean, range 2-20 days) after conventional therapy.
Surgical treatment by VATS is a viable alternative to lateral thoracotomy in patients with recurrent or persisting PSP.
本研究的目的是分析在最初的65例患者中，电视辅助胸腔镜手术（VATS）治疗原发性自发性气胸（PSP）的效率。
从1992年4月至1995年12月，47例男性和18例女性患者，中位年龄28岁（范围17 - 53岁），因持续性（n = 20）或复发性（n = 45）自发性气胸接受VATS治疗。大多数患者使用内镜吻合器缝合肺大疱，随后行壁层胸膜切除术或胸膜摩擦术。将术后参数，如镇痛药的使用、住院时间和引流时间，与1988年1月至1991年12月间接受侧开胸手术治疗的57例患者的对照组进行比较。
6例（9.3%）患者需要转为侧开胸手术。1例患者（1.7%）发生术后并发症，为持续漏气超过7天。无需二次干预。无手术死亡病例。中位随访29个月后发现4例复发。所有复发均发生在术后的前18个月内。与侧开胸手术相比，VATS治疗导致住院时间显著缩短（平均：8天对11天；p < 0.001）和引流时间显著缩短（平均：4天对5天；p < 0.001）。VATS后阿片类镇痛药的使用时间为3.7天（平均，范围1 - 11天），传统治疗后为6.5天（平均，范围2 - 20天）。
对于复发性或持续性PSP患者，VATS手术治疗是侧开胸手术的可行替代方案。
