Video-assisted thoracoscopic surgery for spontaneous pneumothorax - results after 4 years

Summary

A total of 41 cases (11 female, 30 male) for non-malignant spontaneous pneumothorax received thoracoscopic surgery between March 1991 and April 1994. All patients entered a prospective trial. Five conversions to an open procedure were necessary. Of the remaining 36 cases, 30 received thoracoscopic bulla resection and 35 pleurodesis. No patients were lost during the median follow-up period of 24.2 months (minimum 9.7 months). Two partial relapses (5.6%) were noticed. A striking high incidence of sensory loss of the chest wall or pain was observed after coagulation of the parietal pleura or pleur-ectomy (15 out of 33, 45.5%). Severe pain was experienced by only one patient after coagulation (5.5%) compared to four after pleurectomy (26.6%). All three patients without these procedures were free of these complications. An increased recurrence rate may be assumed for cases without any visible changes or with disseminated bullae. After an entire resection of circumscribed bullous changes, additional pleurodesis, with its specific complications, may be an overtreatment. Complications that exceed those of tube drainage treatment limit a more liberal indication for video-thoracoscopic treatment of spontaneous pneumothorax.     

Video-assisted thoracoscopic surgery in the management of spontaneous pneumothorax

Summary

We report on video-assisted thoracic surgery (VATS) in the management ot refractory/recurrent pneumothorax in 43 consecutive patients (16 with refractory and 27 with recurrent pneumothorax). All underwent blebectomy or bullectomy, using an endoscopic stapler and limited apical pleurodesis. Mean age was 42.3 ± 22.7 years; 19 patients had chronic obstructive pulmonary disease. The mean anaesthetic time was 65 ± 19 min, one procedure was converted to thoracotomy because of dense adhesions/bleeding. Complications occurred in eight patients. Two patients developed mild subcutaneous emphysema at the intercostal thoracic drain (ICTD) site; five others developed an air leak which required prolonged ICTD (one of these required a repeat videoscopic procedure and one developed pneumonia). Pain-related morbidity was limited, with mean use of 1.8 doses of parenteral opiate over a mean of 1.5 days and oral analgesics used for 5 ± 3.6 days. Mean follow-up post-procedure was 28.7 ± 17.9 months. One patient developed contralateral resistant pneumothorax (videoscopic blebectomy) and two patients developed ipsilateral pneumothorax; both had a repeat procedure and one had thoracotomy because of further recurrence. We found that videoscopic ablation of blebs was applicable to all but one of 43 patients, with one early failure and two late failures. Procedure-related morbidity was acceptable and no mortality occurred.     

Hypothesis: chest pain in primary spontaneous pneumothorax

The mechanism of chest pain in spontaneous pneumothorax has never been discussed in the literature. It is proposed that this is due to acute parietal pleural irritation secondary to leakage of inflammatory material following bleb rupture, rather than the presence of interpleural air.     

Primary spontaneous pneumothorax.

A spontaneous pneumothorax is a relatively common clinical problem in the United States. A primary spontaneous pneumothorax occurs in otherwise healthy individuals, especially in young adults. It is important for adult-health/medical-surgical nurses to understand the recommended medical treatment and nursing management for patients with spontaneous pneumothorax. Nursing care includes preventing complications, resolving the pneumothorax, managing pain, and educating the patient and family.     

电视胸腔镜治疗原发性气胸临床分析

目的探讨电视胸腔镜（Video—assisted thoracoscopic surery,VATS）治疗原发性气胸的手术方法、手术时间、住院时间及术后复发率。方法回顾分析了我院2008年10月到2009年4月18例原发性白发性气胸VATS手术患者的临床资料。结果18例患者在术前CT检查均发现患侧有肺大疱存在而无肺气肿征象。18例患者的VATS手术时间45—60min,平均50min,住院时间4～10d,平均6d;胸腔引流管放置时间为3～9d,平均5d;随访6个月,1例患者气胸复发,复发率为5．6％。结论实践再次证明VATS治疗原发性气胸是安全的,是一种创伤小、术后疼痛轻、恢复迅速的手术方法。     

Beware spontaneous bilateral pneumothorax.

A previously healthy young man presented to A&E with severe dyspnoea. The cause of his distress was bilateral spontaneous pneumothoraces. Prompt insertion of chest drains relieved his distress. This rare clinical entity should be considered in an individual with severe respiratory distress. Diagnosis is difficult on clinical examination alone.     

Simultaneous bilateral spontaneous pneumothorax: case report.

A 22-year-old previously healthy male was admitted to the emergency department for chest pain and dyspnea of 1-day's duration. He had a history of heavy smoking. The patient was cyanotic, agitated, and severely dyspneic. Lung auscultation revealed severe diffuse bronchospasm and equally diminished breath sounds on both sides. Nasotracheal intubation and mechanical ventilation were performed shortly after admission due to acute respiratory failure. Simultaneous bilateral spontaneous pneumothorax was diagnosed from the chest x-ray, and chest tube drainage was immediately performed bilaterally. Computerized tomography of the chest 1 month later showed diffuse emphysematous bullae of the lungs. The case presented here should increase physicians' awareness of this rare form of spontaneous pneumothorax and its diverse manifestations.     

胸部CT及薄层重建在预测原发性自发性气胸患者复发的应用价值

目的:探讨应用胸部CT检测肺大疱在预测原发性自发性气胸患者复发中的价值。方法:回顾性分析88例第一次发生原发性自发性气胸经保守治疗患者的临床资料包括:年龄、气胸位置、气胸量、胸部CT检查发现肺大疱的数量、位置等以及复发情况、是否吸烟等。结果:88例患者中46例胸部CT发现肺大疱,随访的期限内共有36例复发。胸部CT发现肺大疱与复发有相关性(P<0.01),是否继续吸烟、气胸量的多少与复发无相关性(P>0.05)。结论:肺大疱是预测原发性自发性气胸复发的危险因素,胸部CT联合薄层重建有重要应用价值。     

Simple aspiration as initial treatment for primary spontaneous pneumothorax: results of 91 consecutive cases

Varying opinions exist regarding the choice of initial treatment for primary spontaneous pneumothorax (PSP). This study aims to determine the success rate of simple aspiration of PSP, identify factors associated with failure, and identify associated complications. A retrospective analysis was performed on 91 consecutive patients receiving simple aspiration for PSP at the Emergency Department of a university teaching hospital in Hong Kong, China. The overall success rate was 50.5%. Failed cases had significantly larger sizes of pneumothorax, and significantly larger volumes of air aspirated. Pneumothorax size > or =40% was significantly associated with failure. In a multivariate analysis, pneumothorax size > or =40%, compared to size 21-39%, independently predicted failure, with an odds ratio of 8.88 (95% CI, 2.49 to 31.63). Complications were rarely encountered. It is concluded that the success rate may be significantly improved by excluding patients with pneumothorax size 40% or larger from this modality of treatment.     

安尔碘法胸膜固定治疗原发性自发性气胸的效果

背景：有学者认为对于易复发的原发性自发性气胸应积极行胸腔镜手术治疗,并且术中行胸膜固定能有效降低术后复发率。 目的：探讨安尔碘法胸腔镜治疗原发性自发性气胸的可靠性及有效性。 方法：纳入原发性自发性气胸患者64例,其中男46例,女18例,年龄15-30岁,随机均分为试验组与对照组,两组均进行胸腔镜手术治疗,其中试验组关闭切口前应用干纱布蘸取安尔碘涂抹整个胸腔,对照组未应用安尔碘。比较两组患者的手术时间、术中出血、术后引流量、术后漏气时间,术后拔管时间、术后并发症发病率及术后1年气胸的复发率。 结果与结论：两组手术时间、术中出血、术后漏气时间、术后拔除胸管时间及术后并发症的发生率比较差异均无显著性意义（P ＞0.05）;试验组术后引流量较对照组明显增加（P ＜0.05）,但未造成需医学干预的后果;试验组术后1年复发率低于对照组（P＜0.05）。结果表明胸腔镜手术过程中利用安尔碘涂擦壁层胸膜行胸膜固定,是一种预防原发性自发性气胸术后气胸复发的可靠且有效的治疗方式。     

重症自发性气胸的外科治疗(附48例报道)

目的总结重症自发性气胸外科治疗的经验与效果。方法从以下几方面回顾性总结该院1995～2005年48例重症自发性气胸手术病例的临床资料:重症自发性气胸的临床与X线特点;重症自发性气胸的手术指征;手术方法的选择。结果48例开胸手术取前外侧切口14例,后外侧切口18例,腋下小切口10例,电视胸腔镜(VATS)6例。手术证实自发性气胸由肺大疱所致42例(87.5%),继发于肺结核4例(8.3%),胸腔内粘连带撕裂2例(4.2%)。行单纯大疱结扎14例,大疱切开缝合20例,肺楔形切除6例,肺叶切除2例。术后早期死亡1例,死亡率2%。经1～5年随访,复发1例,对侧气胸1例,其余病例均恢复良好。肺大疱是重症自发性气胸的主要病因。常规手术切口、小切口与胸腔镜处理肺大疱各有优点。结论重症自发性气胸一旦确诊且无绝对禁忌证者应积极外科治疗,手术效果是满意的。腋下小切口较常规切口创伤小,恢复快,但要严格选择适应证,胸腔镜优于腋下小切口和常规切口,值得推荐。如胸腔粘连重,常规切口暴露好,操作方便,应作为首选。     

Recurring spontaneous pneumothorax associated with menses.

A case of catamenial pneumothorax in a 34-year-old woman is presented. Typically recurrent, right-sided pneumothorax associated with menses occurs in a 30- to 40-year-old woman with endometriosis. The right-sided occurrence is attributed to the frequency of congenital perforations of the right hemidiaphragm. Aberrant endometrial tissue is thought to gain access to the right hemithorax and cause pneumothorax with the menstrual slough. Therapy consists of ovulation-suppressing drugs or thoracotomy with pleural ablation for recurrent pneumothoraces. The physician should be aware of the syndrome to make a proper diagnosis.     

单操作孔胸腔镜下治疗原发性自发性气胸28例

目的探讨单操作孔电视胸腔镜下治疗原发性自发性气胸的可行性和相比三孔法胸腔镜手术的优势。方法回顾分析28例原发性自发性气胸的临床资料,全部采用单操作孔电视胸腔镜手术。结果28例患者中肺大疱切除者25例,单纯胸膜摩擦者3例。手术时间20~105 min,平均45 min;术中出血10~120 mL,平均出血40 mL;术后全部顺利出院,未出现并发症;随访1~23个月,无复发病例。结论单操作孔电视胸腔镜手术显著减少了手术创伤,且具有与传统开胸手术或三孔法手术相同的疗效,应进一步推广直至作为原发性自发性气胸的标准术式。