胸腔镜胸膜固定术治疗自发性气胸

自发性气胸保守治疗后的高复发率是一个极待解决的问题。为评价胸腔镜检查以及胸腔镜胸膜固定术     

四环素胸膜内滴注治疗自发性气胸

自发性气胸经保守疗法后持续漏气5～7天以上或反复发作,就有开胸作外科修补手术的指征。但以化学性胸膜粘合术代替则可避免手术痛苦和危险。过去曾应用硝酸银、白陶土、滑石粉和盐酸阿的平作粘合术硬化剂,因都有不可避免的严重反应且疗效不够肯定而已被放弃。本文作者用四环素作硬化剂治疗反复发作的自发性气胸2例,收到显著疗效。作者指出虽然四环素同样产生局部疼痛和发热反应,但只要术前适当处理可无疼痛感觉,发热也是短暂的。具体的做法是:先用盐酸吗啡加安定静脉术前给药,而后用盐酸四环素600mg 稀释于20ml 生理盐水由胸管滴入患侧胸腔,在4小时内帮助患者不断翻身,变换体位。滴注后次     

胸腔镜治疗多发胸膜下肺大疱自发性气胸

目的探讨在自发性气胸电视胸腔镜手术治疗过程中以结扎速处理多发胸膜下肺大疱的可行性及疗效。方法 103例在电视胸腔镜手术中探查发现多发胸膜下肺大疱的自发性气胸患者分为两组,其中Ⅰ组采用低能量电凝治疗,Ⅱ组采用结扎速处理。结果与Ⅰ组相比,Ⅱ组术后胸管留置时间显著缩短(P0.05),两组患者手术时间、使用直线切割缝合器钉仓数目、术中出血、术后持续性肺漏气、术后住院时间以及术后复发,无明显差异(P0.05)。结论在自发性气胸术中以结扎速处理多发散在胸膜下肺大疱疗效满意,值得推广。     

098滑石粉胸膜固定术治疗难治性自发性气胸

文献报告，自发性气胸的复发率为23％－50％，而第一次复发后的再复发率更高。自发性气胸的治疗目的是使肺迅速复张和永久性胸膜固定，其治疗方法尚不一致。无论是胸廓切开胸膜切除术或大瘤切除术，还是电视引导下经胸腔镜胸膜切除术或大疤切除术，创伤均较大，患者难以接受。作者报告用滑石粉胸膜固定术治疗难治性自发性气胸。方法1986、一必纳年间难治性自发性气胸89例。年龄中位数30．5（15－79）岁。难治性自发性气胸的定义为：①复发性自发性气胸；②持续性自发性气胸（插管弓l流7天后持续漏气）；③有严重肺部疾病的继发性自发性气胸…     

胸膜引流套件治疗自发性气胸的临床分析

目的比较胸膜引流套件与套筒针置入硅胶管引流治疗自发性气胸的疗效及并发症。方法将95例自发性气胸病人随机分为两组：观察组（47例）采用胸膜引流套件引流,对照组（48例）套筒针置人硅胶管引流治疗自发性气胸,观察疗效和不良反应。结果胸膜引流套件引流与套筒针置入硅胶管引流治疗自发性气胸,疗效相近,但两组出现不良反应差异有显著性。结论胸膜引流套件治疗自发性气胸具有安全、操作简单、有效、不良反应少的特点,值得推广。     

碘伏胸膜粘连术治疗难治性自发性气胸临床研究

自发性气胸,肺部破口形成后,经胸腔闭式引流治疗,仍然持续漏气的称之为难治性气胸。本病多见于慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)、肺结核患者及少数特发性气胸\[1-8\]。尤其是COPD患者多高龄、有各类慢性肺部基础疾病、不能耐受外科手术或胸腔镜下治疗等原因,这类患者治疗难度大,甚至迁延不愈,且容易反复复发,并能导致增加气胸相关性死亡风险\[9\]。我院采用胸膜     

肺大疱及局部胸膜切除术治疗复发性自发性气胸

肺大疱及局部胸膜切除术治疗复发性自发性气胸李志军，崔永生，刘伟，刘国津临床资料：男３８例，女１０例。４７例为单侧气胸，１例为双侧发病。年龄１６～４２岁，其中２０～３０岁占８８％。３４例为复发２次的自发性气胸，１４例为复发３次或３次以上的病例，本次术前...     

老年患者原发性自发性气胸的外科治疗

原发性自发性气胸主要发生在 2 0岁～ 40岁之间的瘦长男子 ,老年患者 (5 0岁以上 )比较少见。 1995年 8月～ 2 0 0 0年 8月我们共收治 12例。现就病因、临床特征、诊断和治疗效果综合分析如下。1　临床资料本组 12例均为男性 ,年龄位于 5 0岁～ 64岁 ,平均 5 7.5岁。其中右侧气     

四环素胸膜粘连术治疗自发性气胸的长期效果

本次研究目的在于确定四环素胸膜粘连术(TCP)后自发性气胸的复发率,并与未做处置的观察组、单纯安置胸导管及胸廓切开术者对照。 材料与方法1985～1991年,共收治183例自发性气胸(213例次)病人,分为4个治疗组。①组78例次(77例)均予以TCP治疗,用药指征为无活动性肺及胸膜感染而已安置胸导管的各种自发性气胸患者。②组38例次(32例、气胸因<20％均予以观察治疗。③组68例次(66倒)仅安置胸导管。④组29例均行胸廓切开术治疗。 注药前先用阿托品及镇痛剂。经胸导管胸腔内注     

原发性自发性气胸病因研究进展

<正>一、气胸气胸是指气体在胸膜腔内的异常积聚。胸膜腔在生理状态下是一个呈负压状态的潜在性密闭腔隙,在整个呼吸周期的大部分时间内,其压力均小于体外正常大气压。气体进入胸膜腔可能通过下述三种途径:1胸膜腔直接与体外相通,即创伤性气胸(包括外伤、医源性等),胸壁(皮肤、肌肉和/或肋骨以及壁层胸膜存在破损;2胸膜腔与体内部分器官(这部分器官原存在与外界相通如气管、支气管、肺组织、食管甚至胃肠道)交通,其中最常见病因为胸     

Thoracoscopic bullectomy and pleural abrasion in the treatment of primary spontaneous pneumothorax

Although spontaneous pneumothorax is the most common problem seen by the thoracic surgeon, there is no universal agreement in its management. Thoracoscopic bullectomy is preferred to open bullectomy because of minimal trauma, less pain, early recovery and discharge with comparable results. Seventy thoracoscopic bullectomy and apical pleural abrasion in 65 patients with spontaneous pneumothorax were retrospectively reviewed. All but 8 (13%) patients were male with a mean age of 24 years (range 17-55). Only the patients who had a prolonged air leak (> 4 days), reccurence/bilateral pneumothorax occupational reasons and bilateral pneumothorax were the indications for surgical treatment. The patients who had conversion to open thoracotomy were not included in the study. Computerized tomography was performed in all cases prior to the surgery. Endo-GIA 45-60 mm (4.8) staplers (Auto Suture, Tyco, USA) were used for bullectomy using three port access. The apical pleural abrasion following thoracoscopic bullectomy was performed in all cases. One patient developed haematoma on the first postoperative day and underwent open thoracotomy and evacuation of the haematoma. The median hospital stay was 3 (1-11) days. Recurrent pneumothorax was observed in 5 (7.1%) patients. Although thoracoscopic bullectomy is an expensive procedure that requires experience, however reduced pain, shorter hospital stay and early recovery makes it preferred method in such cases.     

Characterisation of pleural inflammation occurring after primary spontaneous pneumothorax.

The aim of this study was to examine the inflammatory reaction occurring in the pleural space of patients suffering from primary spontaneous pneumothorax (PSP) using pleural lavage, which was performed in patients with PSP and in healthy control subjects (essential hyperhidrosis patients undergoing thoracoscopy for sympathicolysis treatment). Cellular and solute composition of lavage fluid, peripheral blood and parietal pleural biopsies were analysed. PSP lavage fluid showed an increase in all differentiated leucocytes, but most strikingly eosinophils and neutrophils. In the blood of patients with PSP, the total number of leucocytes and the absolute number of eosinophils, neutrophils and monocytes were also significantly increased. The time in which air was present in the pleural space was positively correlated with the increase of eosinophils in lavage fluid, parietal pleura and blood. Eosinophilic cationic protein was elevated after PSP and strongly correlated with the absolute number of lavage eosinophils. Chemo and cytokine analysis in lavage fluid showed differences in concentrations of interleukin (IL)-5, IL-6, IL-8, IL-12p40, tumour necrosis factor-alpha and RANTES, but not of eotaxin. Surprisingly, high levels of lipopolysaccharide binding protein were also measured. Primary spontaneous pnumothorax is associated with a substantial pleural inflammatory reaction. The authors hypothesise that mechanical stretch factors, lipopolysaccharide binding protein/lipopolysaccharide complexes or other environmental components trigger pleural inflammation after primary spontaneous pnumothorax.     

自发性气胸治疗进展

自发性气胸是较为常见的胸部疾病,也是常见急诊之一,诊断一般情况下较容易,发病机制目前不是很清楚,治疗方法比较多,包括观察、氧疗、穿刺抽气、闭式引流、胸膜固定术、外科治疗等,但对于多次复发和持续漏气的气胸治理比较困难,目前也没有较好的指南来指导,随着微创外科的发展,给我们提供了新的诊断方法和治疗手段,但还有待进一步的临床实践来证实其安全性和优越性,本文对目前的情况作一综述.     

Management of primary spontaneous pneumothorax

The optimal management of primary spontaneous pneumothorax remains the subject of considerable controversy. During the last few years, however, interesting new data on pathogenesis and various treatment techniques have been published, which have led to the publication of some interesting and thought-provoking opinion articles. The author reviews the latest developments in pneumothorax pathophysiology and management.     

Simultaneous bilateral primary spontaneous pneumothorax

Objective:   While primary spontaneous pneumothorax (PSP) is common in adolescents and young adults, simultaneous bilateral PSP (SBPSP) is rare and can be life-threatening if it progresses to tension pneumothorax. This study reviewed cases of PSP to identify the clinical features of SBPSP.
Methods:   All patients with PSP diagnosed and treated between June 1996 and June 2006 were reviewed, and the clinicoradiological features and outcomes were evaluated.
Results:   Of the 616 patients with 807 episodes of PSP, 13 had SBPSP (1.6%) at first presentation, and all were male (mean age 20.9 ± 4.7 years, range 16–25 years). Compared with the non-SBPSP patients, SBPSP patients had significantly lower body weight and BMI ( P  = 0.018 and <0.001, respectively) and higher body height/body weight ratio ( P  = 0.004). There was no significant difference in their age, sex, smoking habits or body height. Patients with SBPSP had a significantly higher incidence of bleb/bullae seen in HRCT of the lung compared with non-SBPSP (88.5% vs 63.5%, P  = 0.016). In multiple logistic regression analysis, BMI and presence of blebs/bullae were independent risk factors for SBPSP. All patients with SBPSP received bilateral video-assisted thoracoscopic surgery and recovered uneventfully. The mean follow-up period was 3.7 years (range 10 months–7 years).
Conclusion:   Patients with PSP having a lower BMI, and bilateral bleb/bullae formation are at higher risk for the development of SBPSP. SBPSP needs urgent assessment and management, and bilateral video-assisted thoracoscopic surgery is a safe and effective treatment.     

Chemical pleurodesis in primary spontaneous pneumothorax

Spontaneous pneumothorax presents a high recurrence rate after conventional pleural drainage procedures. Different pleural scarifying agents are used in an attempt to prevent early and late recurrence. To investigate the effect of tetracycline and 30%-glucose, we conducted a randomized study on 20 patients with primary spontaneous pneumothorax: 10 patients were treated by pleural drainage combined with chemical pleurodesis; 10 patients were treated by pleural drainage alone. Chemical pleurodesis resulted in a statistically significant reduction (p less than 0.05) in early recurrence. The rate and magnitude of late recurrences however was unaffected by the pleurodesis treatment, although recurrence in the chemically treated group was later than in the conventional drainage group.     

Pathogenesis and treatment of primary spontaneous pneumothorax: an overview

The exact pathogenesis of primary spontaneous pneumothorax (PSP) remains unknown. Furthermore, various specialists including pulmonologists, surgeons, emergency care physicians, radiologists and others are known to treat this disorder in clinical practice. As a consequence, guidelines on the management of PSP are scarce, and differences in treatment approaches persist. In this paper, evidence on the pathogenesis and on various treatment techniques and strategies is reviewed. An algorithmic treatment approach is proposed.     

Contralateral recurrence of primary spontaneous pneumothorax

BACKGROUND: Primary spontaneous pneumothorax (PSP) is a common disease in young adults. With advances in its surgical treatment, ipsilateral recurrence is < 5%. However, contralateral recurrence remains a significant problem. The purpose of this retrospective study was to identify the factors associated with contralateral recurrence of PSP. METHODS: From January 1997 to December 1999, 231 patients with PSP were reviewed and evaluated after an average of 92-months of follow-up. The clinical features and treatment of these patients were analyzed retrospectively. RESULTS: Thirty-three of these patients had contralateral recurrence (14.3%). The average time of contralateral recurrence was 22.94 months. In the univariate analysis (after Bonferroni correction), patients with contralateral recurrence of PSP had lower a body mass index (BMI) [p < 0.001], and higher frequency of contralateral blebs/bullae on high-resolution CT (HRCT) of the lung (p < 0.001). Multiple logistic regression was performed on 128 patients with contralateral blebs/bullae on HRCT of the lung, and the results indicate that being underweight (BMI < 18.5 kg/m(2)) is an independent risk factor for contralateral recurrence (odds ratio, 5.327). All patients with contralateral recurrence of PSP received surgical treatment. Two patients had unilateral recurrences of pneumothorax during follow-up (2 of 64 video-assisted thoracoscopic surgeries, 3%). CONCLUSIONS: Contralateral recurrence of PSP is significantly more common in patients with underweight and blebs/bullae in the contralateral lung. Single-stage bilateral surgery may be considered for these patients to circumvent the need for subsequent anesthetic and operative procedures, and additional hospitalization.