Modified needlescopic video-assisted thoracic surgery for primary spontaneous pneumothorax

Background The objective of this study was to evaluate the feasibility and safety of modified needlescopic video-assisted thoracic surgery (VATS) for treating primary spontaneous pneumothorax. The efficacy between apical pleurectomy and pleural abrasion through this technique was also compared. Methods Between 2001 and 2003, 65 patients with primary spontaneous pneumothorax underwent modified needlescopic VATS procedures. The blebs were resected with endoscopic linear staplers. Pleurodesis was achieved by apical pleurectomy before September 2002 (n = 30) and by pleural abrasion for the remainder of the study period (n = 35). Results Mean operation time was 103 min in the pleurectomy group and 78 min in the abrasion group (p = 0.001). Complications developed in four patients (6.2%): prolonged air leaks in three patients and wound infection in one patient. The mean postoperative hospital stay was 3.8 ± 1.8 days. The two groups had comparable doses of requested analgesics, complication rates, postoperative chest tube and hospital stays, and postoperative pulmonary function test. Ipsilateral recurrence did not occur in any of the pleurectomy group patients after a mean follow-up of 31 months, but it occurred in three patients (8.6%) in the abrasion group after a mean follow-up of 19 months. Conclusions Modified needlescopic VATS provides a feasible and safe procedure for treating primary spontaneous pneumothorax. In terms of efficacy, apical pleurectomy is more effective in preventing ipsilateral recurrence than pleural abrasion.     

Pleurectomy in primary pneumothorax: is extensive pleurectomy necessary?

BACKGROUND: The aim of the study was to evaluate the results of parietal pleurectomy in patients with primary spontaneous pneumothorax comparing extensive pleurectomy performed by thoracotomy versus more limited pleurectomy performed by VATS. METHODS: Records of the patients operated on for primary pneumothorax at Royal Brompton Hospital from January 1994 to April 1997 were retrospectively reviewed. A follow-up questionnaire was sent to patients asking about further pneumothorax and the presence of long-term chest problems on the operated side. A statistical uni- and multivariate analysis was performed searching predictors for postoperative complications, recurrence and chronic chest problems. RESULTS: Thirty-six patients underwent extensive pleurectomy through a limited postero-lateral thoracotomy (40%, group A), 54 patients had a limited pleurectomy (60%, group B), 50 by VATS and 4 by axillary thoracotomy. Overall, 11 patients had postoperative complications (12.2%). In group A, 4 patients (11.1%) had complications (2 reoperation, 2 air leak >7 days). In group B, 7 patients (12.9%) had complications (1 reoperation, air leak >7 days, 1 wound infection). Two patients experienced recurrent ipsilateral pneumothorax after surgery, both belonging to group B (overall recurrence rate 2.5%, group B 4.1%). Thirteen patients in both groups (respectively 41.9% in group A and 27% in group B) admitted chest problems on the operated side. From statistical analysis, "indication" resulted a predictor of complications (p=0.03) and "thoracotomy" a predictor of long-term chest problems (p=0.03). CONCLUSIONS: Many theoretical advantages of limited VATS pleurectomy have still to be confirmed and it is reasonable to use it in uncomplicated primary pneumothorax. The superb exposure obtained with thoracotomy and the superiority of extensive pleurectomy in terms of recurrence indicate this approach in case of complicated pneumothorax or when long-term security is of paramount importance.     

Video-assisted thoracoscopic surgery for spontaneous pneumothorax--a 7-year learning experience

OBJECTIVES: To determine the effect of increasing experience of video-assisted thoracoscopic surgery (VATS) in the treatment of spontaneous pneumothorax (SP) on clinical efficacy and surgical practice. PATIENTS AND METHODS: A prospective study of 180 consecutive operations in 173 patients who underwent VATS for SP by a single surgeon during a 7 year period. RESULTS: 118 patients, mean age 32.1 years (range 13-63 years), were treated for primary spontaneous pneumothorax (PSP) while 55 patients, mean age 65.9 years (range 28-92 years), were treated for secondary spontaneous pneumothorax (SSP). All patients had VAT parietal pleurectomy combined in 162 (90%) patients with stapled bullectomy. At a current median experience of 2.0 years (range 0.4-6.8 years), 12 (6.6%) patients required reoperation for treatment failures within 12 months of surgery--9 patients within 30 days of VATS and 3 for late recurrent pneumothorax. Two patients (both with SSP) died within 30 days of surgery. When compared with PSP, VATS in SSP is characterized by an elderly, male predominance, a longer postoperative stay, a higher mortality rate and a lower rate of late recurrence. With increasing experience of the technique, there has been a significant decrease in treatment failures. In the treatment of PSP, both operating time and postoperative stay have decreased significantly with experience whilst the use of staple cartridges per patient has increased significantly with experience in both PSP and SSP. CONCLUSION: There is a demonstrable 'learning curve' effect on the clinical efficacy and surgical practice of video assisted thoracoscopic surgery for spontaneous pneumothorax.     

Limited axillary thoracotomy vs video-assisted thoracoscopic surgery for spontaneous pneumothorax

Background: Video-assisted thoracoscopic surgery (VATS) has been reported to have a higher pneumothorax recurrence rate than limited axillary thoracotomy (LAT). We investigated the cause of pneumothorax recurrence after VATS by comparing surgical results for VATS and LAT. Methods: Ninety-five patients with spontaneous pneumothorax underwent resection of pulmonary bullae by VATS (n= 51) or LAT (n= 44). Operating duration, bleeding during surgery, number of resected bullae, duration of postoperative chest tube drainage, postoperative hospital stay, postoperative complication, and pneumothorax recurrence were analyzed to compare VATS and LAT in a retrospective study. Results: The duration of surgery, postoperative chest tube drainage, and postoperative hospital stay was significantly shorter in VATS than in LAT cases (p < 0.0005 and p < 0.005). Bleeding during surgery was significantly less in VATS than in LAT cases (p < 0.005). Numbers of resected bullae were significantly lower in VATS (2.7 ± 2.1) than in LAT cases (3.9 ± 2.7) (p < 0.05). Postoperative pneumothorax recurrence was more frequent in VATS (13.7%) than in LAT cases (6.8%), but there was no significant difference. Conclusions: VATS has many advantages over LAT in treating spontaneous pneumothorax, although the pneumothorax recurrence rate in VATS cases was double that in LAT cases. The lower number of resected bullae in VATS than in LAT cases suggests that overlooking bullae in operation could be responsible for the high recurrence rate in VATS cases. We recommend additional pleurodesis in VATS for spontaneous pneumothorax to prevent postoperative pneumothorax recurrence. Received: 13 August 1997/Accepted: 15 December 1997     

Four-year experience with pleural abrasion using a rotating brush during video-assisted thoracoscopy

BACKGROUND: Due to the high recurrence rate in primary spontaneous pneumothorax (PSP), surgical therapy is currently a well-accepted method of treating this condition. There is no general agreement about the best time for surgical intervention (i.e., after the first or second episode) or the optimal surgical approach,--i.e., tube thoracocenteses, thoracotomy, or video-assisted thoracoscopy (VATS) with or without pleurectomy or pleurodesis. The aim of this study was to verify the efficacy of VATS and mechanical brush pleurodesis using a rotating electrical brush system. METHODS: We treated 47 patients with PSP between June 1993 and June 1997. Follow-up ranged from 20 to 56 months. There were 38 male and nine female patients with a mean age of 26 years. Emergency thoracocenteses due to tension pneumothorax became necessary in three patients. All patients were treated by VATS and mechanical brush pleurodesis. Wedge resection was done if bullae or blebs were present (68.1%). RESULTS: Operating time was 20-60 min (mean, 35). There were no intraoperative complications and no conversions to conventional surgery. In the first few postoperative days, postoperative pain was controlled with nonsteroidal antirheumatic drugs and additional morphines. Drainage time was 3-7 days (mean, 4). Hospitalization time was 4-8 days (mean, 5). The recurrence rate was 2.1% (one patient). No postoperative bleeding or wound infection occurred in any of our patients. CONCLUSIONS: VATS combined with mechanical brush pleurodesis using the electrical brush system is a highly effective and safe treatment for patients with recurrent primary spontaneous pneumothorax.     

Impact of additional pleurodesis in video-assisted thoracoscopic bullectomy for primary spontaneous pneumothorax

BACKGROUND: Bullectomy for primary spontaneous pneumothorax has been associated with high postoperative recurrence rates when video-assisted thoracoscopic surgery (VATS) has been used rather than thoracotomy. The aim of this study was to evaluate the efficacy and identify the disadvantages, if any, of adding pleurodesis to VATS bullectomy to prevent recurrent pneumothorax. METHODS: Fifty-three patients who underwent VATS bullectomy with additional pleurodesis for pneumothorax after November 1996 and 50 who underwent VATS bullectomy alone before October 1996 were compared retrospectively in terms of intraoperative factors and postoperative chest pain, pulmonary function, and pneumothorax recurrent rates. Pleurodesis was achieved by electrocauterizing the upper surface of the parietal pleura in a patchy fashion. RESULTS: There were no significant differences between the additional pleurodesis group and the bullectomy alone group in terms of age, sex, operating time, intraoperative bleeding, number of resected bullae, duration of chest drainage, or volume of fluid drained. Postoperative chest pain and pulmonary function were also similar in both groups. A recurrent pneumothorax occurred in one patient (1.9%) in the additional pleurodesis group; this recurrence rate was significantly lower than that for the bullectomy alone group (eight patients, 16%; p = 0.029). Although the mean postoperative follow-up period was considerably shorter in the additional pleurodesis group (38 months [range, 26-49]) than in the bullectomy alone group (63 months [range, 50-72] ), eight (89%) of all nine recurrences occurred within 26 months of surgery-i.e., within the minimum follow-up period for the additional pleurodesis group. CONCLUSIONS: Pleurodesis is a minimally invasive technique that is effective in preventing postoperative recurrences of pneumothorax when added to VATS bullectomy. Additional pleurodesis has no disadvantages vs bullectomy alone in terms of worsening postoperative chest pain or pulmonary function.     

Less invasive needle thoracoscopic laser ablation of small bullae for primary spontaneous pneumothorax.

OBJECTIVE: The purpose of this study was to establish a new surgical technique of thoracoscopic laser ablation for the patients of primary spontaneous pneumothorax (PSP) with small bullae, by using endoscopic equipment with a 2-mm diameter. METHOD: According to the size of a bulla identified by high-resolution computed tomography (HRCT), we have a protocol to determine an indication; the conventional video-assisted thoracic surgery (VATS) procedure by both stapler bullectomy and laser ablation to visceral pleura surrounding the bulla (bullae size: greater than 2 cm), or a new VATS procedure using needle shaped thoracoscopy and endoscopic equipment with a 2-mm diameter (needle VATS) by laser bulla ablation alone (bullae size: less than 2 cm). RESULTS: The conventional VATS was performed in 54 patients and needle VATS in 60 patients. In the needle VATS group, operation time was shorter than that of the VATS group (39+/-17 min vs. 56+/-22 min). Use of non-steroidal anti-inflammatory drugs for postoperative wound pain could be reduced in the needle VATS group (3% vs. 56%). There were no complications in the needle VATS group, but three complications (5.6%) in the VATS group, including prolonged air leakage (>4 days) in two and refractory intercostal pain in one. The rate of recurrence after the operation was similar in both groups (3.7% vs. 3.3%). The needle VATS allowed wound healing without a scar and reduced the patient's cosmetic problems. CONCLUSION: The needle VATS procedure for patients with a bulla size less than 2-cm diameter was as useful as the conventional VATS procedure.     

Uniportal video-assisted thoracic surgery for primary spontaneous pneumothorax: clinical and economic analysis in comparison to the traditional approach

We aimed to verify the clinical and economic effects of uniportal video-assisted thoracic surgery (VATS) in patients with primary spontaneous pneumothorax (PSP) compared to traditional three-port VATS technique. We analyzed 51 consecutive patients (23 three-port VATS and 28 uni-port VATS), treated by bullectomy and pleural abrasion, to detect differences between the two groups with regard to intraoperative management, postoperative course, pain, paraesthesia and costs. Data about pain and paraesthesia were collected by telephonic interview within a minimum follow-up period of six months. Compared to three-port VATS, patients treated by the uni-port VATS were discharged more quickly (3.8 days vs. 4.9 days, P=0.03) and experienced paraesthesia less frequently (35% vs. 94%, P<0.0001). No difference in chronic pain was observed between the two groups (numeric pain score: 0.6 uni-port vs. 1.3 three-port, P=0.2). Compared to three-port VATS, we found a significant reduction in postoperative costs for the patients operated on by the uni-port technique (euro1407 vs. euro1793, P=0.03), without any increase in surgical costs. In conclusion, uniportal VATS appears to offer better clinical (postoperative stay and rate of paraesthesia) and economic (postoperative costs) results than the standard three-port VATS for treating primary spontaneous pneumothorax.     

Uniportal vs standard three-port VATS technique for spontaneous pneumothorax: comparison of post-operative pain and residual paraesthesia.

OBJECTIVE: VATS using the conventional three ports is currently the technique of choice for blebectomy/bullectomy for spontaneous pneumothorax. However, the procedure has recently been shown to have neurological complications related to the port sites. Uniportal VATS has recently been proposed as an alternative to conventional three-port VATS. It is anticipated that the single incision will predispose to a lower incidence of neurological complications. METHODS: We report our initial single surgeon experience of uniportal VATS (n = 16) and provide a comparison of post-operative pain and residual paraesthesia to conventional three-port procedures (n = 19) for the same pathology. RESULTS: In both groups, the pneumothorax pathology was principally primary. There was no difference between the groups in terms of age, spirometry, tissue resected, drainage time and inpatient stay. A difference was, however, noted in inpatient pain scores. The uniportal group had a lower median score of 0.4 (visual analogue range 0-4) while the three-port technique reported 0.8 (P = 0.06, Mann-Whitney test). The maximum score trend was similar (1.4 vs. 2.6, respectively, P < 0.001, Mann-Whitney test). Follow-up for uniportal and three-port VATS averaged 9.4+/-6.6 and 32.1+/-9.9 months, respectively. One patient in the three-port group had a pneumothorax recurrence. Three-port VATS also had a higher residual pain score (0.5) compared to uniportal VATS (0.3). Of clinical significance was the incidence of neurological complications. Eighty-six percent of uniportal patients reported no symptoms. The remaining experienced only mild 'numbness' or 'swelling'. However, in the three-port group, only 42% reported no symptoms. A similar number experienced 'numbness'. Two females described sexual dysfunction due to altered breast sensitivity. Seventeen percent (2/12) reported 'pins and needles'. CONCLUSIONS: Uniportal VATS appears to be tolerable, safe and efficient in treating spontaneous pneumothorax in our series. Moreover, post-operative pain and paraesthesia incidence was lower than three-port VATS. Prospective randomised trials are important to evaluate this technique.     

Video-assisted thoracoscopic management of recurrent primary spontaneous pneumothorax after prior talc pleurodesis: a feasible, safe and efficient treatment option.

OBJECTIVE: To assess the role of video-assisted thoracoscopic surgery (VATS) in the management of a recurrent primary spontaneous pneumothorax after a prior talc pleurodesis. METHODS: From 1996 to 2002, we retrospectively reviewed all patients who were treated for a recurrent primary spontaneous pneumothorax after a previous talc pleurodesis. Data on the talc procedure and the recurrent pneumothorax, delay between both, and operative features were studied. Conversion rate to a thoracotomy and postoperative complications as well as long-term outcome were reported. RESULTS: We collected 39 patients (28 male) with a median age of 25 years (15-41 years). The initial procedure consisted of thoracoscopic talc poudrage in all cases. The median delay between the talc procedure and the recurrence was 23 months [10 days-13 years]. Size of recurrence involved 10-80% of the hemithorax. The VATS procedure was successfully achieved in 27 patients (69%) while 12 required conversion to a thoracotomy. The main cause for conversion was the presence of dense pleural adhesion at the mediastinal part of the pleural cavity. Postoperative morbidity was limited to pleural complications in the VATS group (n=6, 22%). Median follow-up was 26 months [10-38 months]. One patient treated by VATS developed a partial recurrent pneumothorax at 12 months with a favorable outcome without further surgery. CONCLUSIONS: Feasibility, safety and efficacy of VATS for management of recurrent primary spontaneous pneumothorax following thoracoscopic talc poudrage are strongly suggested.     

Video-assisted thoracic surgery in the treatment of spontaneous pneumothorax

BACKGROUND: The aim of this study was to evaluate the surgical indications and the results of a series of 107 patients treated by video-assisted thoracic surgery for spontaneous pneumothorax with a minimum follow-up of 12 months. METHODS: From January 1991 to December 1997, 107 patients (86 male and 21 female patients) mean age 28 years (range 14-78), underwent VATS for treatment of spontaneous pneumothorax. RESULTS: Seventy-five patients had primary spontaneous pneumothorax (PSP) and thirty-two patients had secondary spontaneous pneumothorax (SSP). Bullous area was not seen in 26 patients with PSP. Ninety-nine patients were treated with wedge stapled resection of the bullous area or of the apex (when no bullous area was seen) and some form of pleurodesis, whereas 8 patients with PSP were treated only with pleurodesis. Among these 8 patients, two presented recurrence. Two patients with PSP and 8 patients with SSP were treated by apical pleurectomy: no one developed recurrence. The other 97 were treated with electrocoagulation of the parietal pleura. Conversion to a thoracotomy was necessary in 4 patients (12.5%) because of massive pleural adhesions. There were no postoperative deaths. A complication developed in 3 patients (4%) with PSP and in 5 patients (17.8%) with SSP, whose procedure was ended by VATS. The duration of systematic postoperative drainage was 3.8 +/- 0.9 (range 3-15 days) for the group of patients with PSP and 6 +/- 2.1 (range 4-23 days) for the group of patients with SSP. The duration of the hospital stay was 5.6 +/- 1.4 (range 4-15) and 8.4 +/- 2.3 (range 6-18) in patients with PSP and SSP respectively. Follow-up analysis revealed 2 (2.66%) ipsilateral recurrent pneumothorax in 75 patients treated for PSP. Among 26 patients with SSP, whose procedure was completed by VATS, 2 recurrences (7.7%) were observed. CONCLUSIONS: Surgical treatment by VATS is a valid alternative to open thoracotomy in patients with PSP and will be the treatment of choice because, with increased experience of surgeons, it will yield the same results as standard operative therapy but with the advantages of the minimally invasive operation. The usefulness of VATS in patients with SSP remains to be defined.     

Stapler blebectomy and pleural abrasion by video-assisted thoracoscopy for spontaneous pneumothorax

BACKGROUND: This study aims to evaluate the efficacy of video-assisted thoracoscopic surgery (VATS) pleurodesis in the treatment of spontaneous pneumothorax with particular reference to the postoperative period and the rate of recurrence after pleural abrasion. METHODS: One hundred and thirty-three patients who underwent VATS management of primary spontaneous pneumothorax were retrospectively reviewed. They were 113 males and 20 females with median age of 26 (range 12-37). Among these patients, 114 underwent VATS for recurrent pneumothorax and 19 for persistent air-leakage at the first episode. During surgical procedure, in 78% of cases, parenchymal blebs were identified and resected by stapler resection. All patients were submitted to pleural abrasion. RESULTS: No intra- or postoperative deaths occurred. Postoperative complications were persistent air-leak for more than 7 days in 6 patients (4.3%) bleeding in 3 patients (2.2%). The median chest-tube duration and hospital stay were 2 (range 2-11) and 3 (range 3-12) days, respectively. Median follow-up period of 53 (range 6-96) months was complete for all patients. Five episodes of recurrent pneumothorax were encountered and 4 of them, because of major entity, required re-do VATS with stapler resection and pleural abrasion: their postoperative period and residual follow-up was uneventful. CONCLUSIONS: The goal in the surgical management of spontaneous pneumothorax, which often affects "apparently healthy" young patients, is to secure the less recurrence rate with no mortality and quite null morbidity and functional impairment. VATS stapler resection and pleural abrasion is a safe procedure allowing a good management of the disease with low complication rate, short chest-drain duration, hospital stay and recurrence rate quite similar to those referred for other procedures such as pleural poudrage or limited pleurectomy.     

Recurrence rate after thoracoscopic surgery for primary spontaneous pneumothorax

Objectives: There is an on-going discussion regarding the recurrence rate after surgery for primary spontaneous pneumothorax by video assisted thoracic surgery (VATS) or by thoracotomy access. This study aimed to describe the recurrence rate, and to identify a possible learning curve, following surgery for primary spontaneous pneumothorax by VATS. Design: All patients who underwent surgery for primary spontaneous pneumothorax by VATS at Karolinska University Hospital 2004–2013 were reviewed. Preoperative and operative characteristics were obtained from medical records. Patients were followed-up through telephone interviews or questionnaires and by review of medical records. The primary outcome of interest was time to recurrence of pneumothorax requiring intervention. Outcomes were compared between patients operated during 2004-June 2010 and July 2010–2013. Results: 219 patients who underwent 234 consecutive procedures were included. The mean follow-up times were 6.3 and 2.9 years in the early and late period, respectively. The postoperative recurrence rate in the early period was 16% (11%–25%), 18% (12%–27%), and 18% (12%–27%), at 1, 3 and 5 years, compared to 1.7% (0.4%–6.8%), 7.6% (3.7%–15%), and 9.8% (4.8%–19%) at 1, 3 and 5 years, in the late period (p?=?0.016). Conclusions: We found that the recurrence rate after thoracoscopic surgery for primary spontaneous pneumothorax decreased significantly during the study period. Our results strongly suggest that thoracoscopic surgery for pneumothorax involve a substantial learning curve.     

Long-term effect of a thoracoscopic stapled bullectomy alone for preventing the recurrence of primary spontaneous pneumothorax

Purpose  The purpose of this retrospective study was to determine the long-term efficacy of a stapled bullectomy without any symphysial procedures under videoassisted thoracoscopic surgery (VATS). Methods  A total of 121 sides of 112 patients who underwent a stapled bullectomy alone for primary spontaneous pneumothorax were retrospectively reviewed. There were 48 sides of 45 patients who underwent VATS (VATS group) and 73 sides of 67 patients who underwent open surgery (thoracotomy group). Results  There were 12 recurrences that occurred during the follow-up periods in the VATS group (24.5%), and 3 in the thoracotomy group (4.1%). The cumulative recurrence rates in the VATS group at 2 and 10 years after a bullectomy were 16.3% and 27.5%, whereas in the thoracotomy group the recurrence rates were 2.9% and 4.9%, respectively (P < 0.001). Conclusions  The long-term outcome of a VATS stapled bullectomy was unsatisfactory as a radical therapy for primary spontaneous pneumothorax. A symphysial procedure should therefore be added to VATS stapled bullectomy in order to prevent long-term postoperative recurrence.     

Video-Assisted Thoracoscopic Surgery for Recurrent Spontaneous Pneumothorax: The Long-term Benefit

Background Management of recurrent primary spontaneous pneumothorax by open surgery was considered the treatment of choice until recently. The major drawbacks of this management are the prolonged postoperative pain and cosmetic results. In the last decade, video-assisted thoracoscopic surgery (VATS) has replaced the routine use of open surgery. Most papers that compared limited open surgery to VATS addressed the early postoperative results, and studies that assessed the long-term results focused primarily on the rate of recurrence and pulmonary function tests. The aim of this study was to compare the outcome of minithoracotomy and VATS with emphasis on patients’ long-term, subjective perspective and satisfaction. Methods Medical records of patients with recurrent primary spontaneous pneumothorax were retrospectively reviewed. Patients who underwent surgical treatment by limited thoracotomy (63 patients) or VATS (58 patients) more than 3 years ago were enrolled. Hospital medical charts were used to compare the early postoperative results. Outpatient clinic records and a telephone questionnaire were employed to evaluate long-term results. Results There was no mortality or major morbidity in either group, and hospitalization time was similar. Patients in the thoracotomy group needed significantly higher doses of narcotic analgesia for a longer period. There were two cases of recurrence in the VATS group (3%). Seventy-eight percent of patients in the VATS and 21% in the thoracotomy group classified their pain as insignificant a month following the operation (P < 0.05). Three years following surgery, 97% of the VATS group patients considered themselves completely recovered from the operation compared with only 79% in the thoracotomy group (P < 0.05). Nineteen percent of the thoracotomy group and 3% of the VATS group suffered from chronic or intermittent pain necessitating use of analgesics more than once a month. Thirteen percent of patients from the open procedure group required services from the pain clinic. Patients in the VATS group were, in general, much more satisfied with their operation and with the surgical scars compared with patients from the thoracotomy group. Conclusion We recommend video-assisted surgery as the first-line surgical treatment for patients with recurrent primary spontaneous pneumothorax. This recommendation is based on its somewhat favorable early postoperative course, the superior long-term outcome, and patient satisfaction.     

胸腔镜下单操作孔手术与开胸手术治疗肺大疱的临床比较

目的观察胸腔镜下单操作孔手术与开胸手术治疗原发性自发性气胸(PSP)伴肺大疱形成的效果。 方法通过回顾性收集2008年1月至2015年12月52例PSP伴肺大疱形成患者分成两组,A组30例[电视胸腔镜(VATS)下单操作孔肺大疱切除术],B组22例(常规开胸手术),比较两组的住院时间、术前和术后的血气分析[动脉血氧分压(PaO₂)、动脉血二氧化碳分压(PaCO₂)]、术后胸腔积液、胸顶残气、漏气、肺不张、肺部感染、术后复发等相关并发症。 结果与B组比较,A组的住院时间(t＝1.312,P＝0.036)、术后血气分析PaO₂(t＝60.206,P＝0.038)、PaCO₂(t＝32.025,P＝0.009)、胸腔积液(t＝2.035,P＝0.042)、肺部感染(t＝1.095,P＝0.041)差异有统计学意义(P< 0.05),治疗效果A组明显优于B组;与B组比较,A组的术后胸顶残气、漏气、肺不张、术后复发,差异无统计学意义(P> 0.05)。 结论采用VATS下单操作孔肺大疱切除术治疗PSP安全、有效,具有创伤小,并发症少,优于常规开胸手术治疗,能够在最短时间治愈PSP。早期VATS下单操作孔肺大疱切除术治疗PSP可作为优先治疗,具有可能性、必要性,具有较高的临床应用价值。     

电视胸腔镜手术与胸腔闭式引流术治疗老年白发性气胸的疗效分析

目的对比分析电视胸腔镜手术与传统胸腔闭式引流术对于老年自发性气胸治疗的疗效差异。方法回顾性分析2011年3月至2013年5月135例老年自发性气胸患者的临床治疗及其效果。结果采用电视胸腔镜手术的97例患者,其住院时间、术后并发症及气胸复发的几率均明显低于采用胸腔闭式引流术的38例患者,两者比较,差异具有统计学意义（P〈0．01）。结论电视胸腔镜治疗老年自发性气胸,具有患者痛苦小,并发症的发生率低,病程短,复发率低,疗效确切等优点,与胸腔闭式引流相比较,其疗效有明显的优势。     

A cost-effective thoracoscopic treatment strategy for pediatric spontaneous pneumothorax

Background: Recent data suggest that children have a higher incidence of recurrence than adults after nonoperative treatment of primary spontaneous pneumothorax (PSP). Video-assisted thoracoscopic surgery (VATS) allows efficacious therapy with significantly less morbidity. We attempt to define the most cost-effective clinically efficacious strategy using VATS to manage pediatric PSP. Methods: We retrospectively reviewed all admissions to a tertiary care children's hospital for PSP between January 1, 1991 and June 30, 1996. Results: Fifteen children had 29 primary or recurrent PSPs. Mean patient age was 14.8 ± 1.1 years, boy–girl ratio 4:1, median body mass index 18 (normal, 20–25), and 67% of pneumothoraces left sided. All patients were managed initially nonoperatively: 14 with tube thoracostomy drainage and 1 with oxygen alone. Of the children initially managed nonoperatively, 57% had a recurrent pneumothorax, and 50% of these patients eventually developed contralateral pneumothoraces. Nonoperative treatment for recurrence resulted in a 75% second recurrence rate. In contrast, eight children who underwent operative management had a 9% incidence of recurrence. The total for charges accrued in treating 29 pneumothoraces in these 15 patients was approximately $315,000. In the same population, the estimated charges for initial nonoperative therapy followed by bilateral thoracoscopy after a single recurrence would be $230,000. Conclusions: A cost-effective treatment strategy for pediatric primary spontaneous pneumothorax is tube thoracostomy at first presentation, followed by VATS with thoracoscopic bleb resection and pleurodesis for patients who experience recurrent pneumothorax. Received: 15 May 1998/Accepted: 15 January 1999     

电视胸腔镜处理自发性气胸疗效分析

目的　评价电视胸腔镜 (VATS)处理自发性气胸的疗效。　方法　将手术治疗的自发性气胸分为VATS组和剖胸组 ,按原发性和继发性进行术中术后各种参数的回顾性分析。　结果　与剖胸组相比 ,VATS组在术中出血量、手术时间及术后住院时间方面明显优于对照组。VATS组和剖胸组术后并发症发生率分别为 8.4%和 2 0 .9% (P <0 .0 5 ) ,近期漏气率分别为 5 .6%和 7% (P >0 .0 5 ) ,远期复发率分别为 2 .8%和 2 .3% (P >0 .0 5 )。　结论　与剖胸术比较 ,VATS更易被病人接受 ,总的疗效较优 ,应作为自发性气胸的首选治疗方法     

Recurrences following videothoracoscopic treatment of primary spontaneous pneumothorax: the role of redo-videothoracoscopy.

OBJECTIVE: There is very little experience regarding recurrences following videothoracoscopic (VATS) treatment of primary spontaneous pneumothorax. We report our experience with 19 patients who underwent redo-VATS to evaluate the feasibility of such surgical approach. METHODS: From July 1, 1992 to September 1, 2000, out of 2136 VATS procedures performed at our institution, 597 patients (27.94%) underwent VATS treatment of primary spontaneous pneumothorax with a recurrence rate of 3.85% (23 cases). Primary VATS treatment in these patients was: talc poudrage, three cases; subtotal pleurectomy, three cases; ligation of the bullae + subtotal pleurectomy, 12 cases; stapling of the bullae + subtotal pleurectomy, two cases; ligation of the bullae + talc poudrage, one case; stapling of the bullae + talc poudrage, one case. Treatment of the 23 recurrences included: 15 redo-VATS, four standard thoracotomy, three pleural drainage, one bed rest. Four additional redo-VATS were also performed in four patients operated on in different institutions. Redo-VATS showed residual bullae in nine cases and a minimal leaking area in one patient; in the remaining nine patients no lesion was found. Redo-VATS treatment was: stapling of the bullae + talc poudrage in nine patients; suture of the leaking area with a no-knife stapler + talc poudrage in one patient; isolated talc poudrage in the remaining nine patients with no-evidence of bullae or blebs. RESULTS: No mortality was reported; no major complications occurred. The conversion rate in the group of redo-VATS was 5.2% (one patient). At a mean follow-up of 32 months no patient showed recurrent pneumothorax. CONCLUSIONS: In the light of our initial experience, redo-VATS seems to be a promising tool for the surgical therapy of recurrences following VATS treatment of primary spontaneous pneumothorax.