肺结核患者并发自发性气胸32例临床分析

目的探讨肺结核与自发性气胸的发病关系和临床特点。方法对32例肺结核并发自发性气胸进行回顾性分析。结果32例患者,闭合性气胸25例,开放性气胸5例,张力性气胸2例。部位：左侧气胸15例,右侧气胸11例,双侧气胸6例;肺压缩程度〈20%7例,20%～50%22例,〉50%3例。除7例肺压缩程度〈20%、症状不明显采用保守治疗外,25例采取胸腔闭式引流。愈合29例,2例支气管胸膜瘘伴脓气胸转外科治疗,1例死于呼吸衰竭。结论肺结核合并自发性气胸,临床症状重,及时救治,预后良好。     

老年人自发性气胸68例分析及治疗策略

目的探讨老年人(>60岁)自发性气胸的误诊分析及治疗策略。方法采用本院自2000年1月￣2004年12月收治60岁以上自发性气胸患者共68例,进行临床分析,探讨误诊原因及最安全、最有效的治疗方法。结果老年人自发性气胸的病因以慢性阻塞性肺疾病、继发性肺结核、支气管肺癌为主,其次为支气管哮喘。老年人自发性气胸误诊率36.8%,其中误诊为急性左心衰占14.5%,哮喘占11%。治疗上闭式引流术 胸膜固定术的治愈率85.3%,单纯胸腔穿刺治愈率14.8%。结论由于多伴有基础肺疾病,误诊率高,治疗难度大,易反复发作,临床上以闭式胸腔引流和/或 胸膜固定术最有效,最安全。     

Video-assisted Thoracoscopic Surgery in Early Evaluation of First Time Spontaneous Pneumothorax： A Retrospective Study

Objective To analyze the differences in efficacy and costs in treating first time spontaneous pneumothorax by conservative therapy （pleural drainage or observation） and video-assisted thoracoscopic surgery （VATS）. Methods 59 Patients with first time spontaneous pneumothorax were retrospectively divided by either a continuous tube thoracostomy with/without negative pressure absorption （group 1,n=31） or VATS （group 2, n=28） after placement of the first chest tube for 48-72 hours. Patients in group 1 with additional intervention failed were divided subsequently randomly to VATS group （n=5） or thoracotomy group （n=10）. Study end points included duration and costs of hospitalization. Results： Patients in group 2 had shorter duration of tube drainage （4.56 1.74, versus 7.63 4±3.46 days, p〈 0.05）, shorter total hospital days （7.84±3.86 versus 10.96±4.27 days, p〈0.05） compared to patients in group 1. Hospital costs were higher in group 2 than that in group 1 （￥15.365±4.478 versus ￥8.894±6.423, p〈0.05）. There was no mortality in either group. No patient of group 2 was required to convert to thoracotomy group. 15 patients of group 1 with prolonged tube placement failed, and this subset was divided to VATS group （n=5） or thoracotomy group （n=10）. No significant difference in clinical outcome was found between with two subgroups. Conclusion： Intent to treat with early VATS for first time spontaneous pneumothorax decreases the duration of tube drainage, the length of hospital days and potentially reducing hospital costs if disposable Endo-devices were not used in VATS.     

Tetralogy of Fallot with absent pulmonary valve: a case complicated by bilateral relapsing pneumothorax

We report a case of a neonate with tetralogy of Fallot with aneurysmal dilatation of the pulmonary artery, complicated by bilateral relapsing pneumothorax. The relapsing air leak made it necessary to place up to five chest drains and to switch from conventional ventilation to high frequency ventilation. In the course of 30 days, all drains were removed. Once other anatomical and functional malformations of the respiratory system had been appropriately excluded and reasonable haemodynamic stability had been achieved, the patient underwent successful radical corrective heart surgery in hypothermia and cardioplegia. We emphasize the advantage of resolving respiratory failure preoperatively to guarantee the success of corrective heart surgery and treatment of other surgically severe cases.     

Lung mechanics with tension pneumothorax during mechanical ventilation

Key words  lung mechanics - mechanical ventilation - tension pneumothorax     

Thoracoscopic treatment for primary spontaneous pneumothorax at a general hospital

Summary. Video-assisted thoracoscopic surgery is now recommended for the treatment of primary spontaneous pneumothorax. We studied the validity of this method at our general surgical department in a prospective group with regard to effectiveness and complication rate. The combination of thoracoscopic bulla resection with tetracycline pleurodesis resulted in a 100 % recurrence-free rate of 28 pneumothoraces at a median follow-up of 19 months. We observed no intraoperative complications. We conclude that video-assisted thoracoscopic surgery is an effective treatment for primary spontaneous pneumothorax and can safely be carried out even in a general surgical unit. The legal aspects are discussed in detail.      

Video-assisted blebectomy using a flexible scope and a bleb implement

(Received for publication on Dec. 28 1998; accepted on Sept. 17 1999)     

慢性阻塞性肺病合并自发性气胸的临床特点

目的：探讨慢性阻塞性肺病（COPD）合并自发性气胸的特点,提高临床治疗水平。方法：对近5年间收治的56例COPD并发自发性气胸进行系统性回顾分析研究。结果：COPD并发自发性气胸患者年龄偏大,平均60.2岁,所有病例都存在严重的肺气肿,临床缺乏特异性,张力性气脑发生率高达48．2％,死亡率达14．3％,复发性气胸并非罕见,发生2次或2次以上者达25．0％。结论：COPD并发自发性气胸起病隐匿,进展快,常危及生命,必须提高诊断率,及时处理。     

Radiation-induced pneumothorax

Pneumothorax is an uncommon complication of radiation therapy to the chest. The proposed pathogenesis is radiation-induced fibrosis promoting subpleural bleb formation that ruptures resulting in pneumothorax. We report on two young patients with primary sarcomas without pulmonary metastases who developed spontaneous pneumothorax after irradiation. Neither patient had antecedent radiographic evidence of pulmonary fibrosis.     

滑石粉治疗老年性气胸42例疗效观察

目的:探讨滑石粉治疗老年性气胸的疗效。方法:使用滑石粉疗法,先从胸腔引流管中一次性注入利多卡因100 mg局麻止痛,再用无菌滑石粉2 g溶解于生理盐水20 ml中,从胸腔引流管中一次性注入,让患者翻身使药液分布均匀。2周后若气胸不愈合,再给滑石粉治疗1次,最多不超过3次。结果:42例患者中,使用上述方法1次后,有33例气胸愈合,其中最短4天,4例用药2次后愈合,3例用药3次后愈合,其中最长1例116天,另2例气胸不愈合患者中1例转外科手术,1例死于肺部感染。结论:滑石粉治疗老年复发性气胸疗效明确,若能正确使用,并尽量减轻其不良反应,不失为治疗老年性气胸的一种好方法。