自发性气胸的病因学研究进展

自发性气胸是临床常见病,某些情况下可危及生命.尽管其治疗已经取得了不小进步,但发病机制复杂,病因尚未完全阐明,且复发率高.对其病因学近年研究进展加以概括,可能有助于加深对该病的理解.     

36例自发性气胸诊断与治疗分析

目的　探讨自发性气胸的诊断与治疗。方法　对1 994～2 0 0 4年收治的自发性气胸36例作回顾性分析。结果　36例自发性气胸患者,除1例因误诊而延误救治外,其余患者经保守治疗、单纯针刺抽气、胸腔闭式引流、内科粘着疗法等综合治疗,效果满意。结论　典型的自发性气胸通过症状、体征及相关检查不难做出正确诊断,但要注意与相关疾病鉴别。     

The role of thoracoscopy in the evaluation and management of pneumothorax

In experienced hands thoracoscopy is an innocuous, inexpensive, and effective form of treatment for patients with pneumothorax.     

胸腔镜治疗首次和复发性气胸

目的 探讨胸腔镜治疗首发性气胸和复发性气胸的术式、手术适应证及远期疗效。方法 1995年1月～2001年12月胸腔镜手术治疗自发性气胸173例，157例为特发性气胸(PSP)，16例为继发性气胸(SSP)。PSP组中首发65例(占41．4％)，发作1次以上的92例(占58．6％)，其中双侧同时气胸同时手术3例，双侧不同时气胸分别手术6例。SSP组，10例首次发作，6例发作1次以上。结果 按照Vanderschueren分类，内镜下发现无病灶的34例(19．7％)，胸膜粘连41例(23．7％)，有肺大疱98例(56．7％)。手术以胸膜融合术及Endo-cutter内镜下切割吻合为主。术后并发症发生率3．0％，包括皮下气肿、局限性胸膜渗出、漏气时间延长。全组患中位随访53个月，3例气胸复发，发生率1．80A，，因气胸局限均保守治疗痊愈。结论 随着胸腔镜手术的改进，它将逐渐成为治疗SP的首选方法，为初发、复发气胸的患普遍接受。     

肺结核并发自发性气胸74例临床分析

目的　探讨肺结核并发自发性气胸的相互关系。结果　对 74例患者中 ,单纯性气胸 34例 (4 5 .94 % ) ,开放性气胸 36 (4 8.6 4 % ) ,张力性气胸 4例 (5 .6 % ) ;部位 :左侧 38例 (5 1.35 % ) ,右侧 34例 (4 5 .95 % ) ,双侧2例 (2 .7% ) ;肺压缩 >5 1% 2 1例 (2 8.38% ) ; 肺结核 71例 (96 % ) ,病变范围 :<3个肺野 37例 (5 0 % ) ,≥个肺野37(5 0 % ) ,合并肺大泡 13例 (17.5 6 % )。74例经治疗后 ,6 7例 (90 .5 4 % )治愈 (肺完全复张 ) ,5例好转 ,1例转胸外科治疗 ,1例死于大咯血。结论　肺结核并发自发性气胸时 ,临床症状重 ,及时救治 ,预后良好。     

Factors related to recurrence of spontaneous pneumothorax

OBJECTIVES: The purpose of this retrospective study was to identify factors associated with recurrent spontaneous pneumothorax (SP) in southern China, and to compare the therapeutic effectiveness of different procedures. METHODS: A total of 182 consecutive patients (89.0% male; mean age, 38.9 years), admitted with their first episode of pneumothorax, were reviewed retrospectively. Follow up was available in 138 patients (75.8%), including 68 treated by chemical pleurodesis and 70 by chest tube drainage alone. The cumulative recurrence rates with different therapeutic procedures and different chemical sclerosing agents were compared, and the factors that influenced the recurrence rate were analysed using Cox's proportional hazard model. RESULTS: The most common pre-existing lung disease responsible for pneumothorax was COPD (69.7%), followed by tuberculosis (16.5%). Recurrence was significantly more common in taller patients, patients with lower weight, and patients with secondary spontaneous pneumothorax. The cumulative recurrence rates in the pleurodesis therapy group after 6 months, 1 and 3 years were 13, 16 and 27%, respectively, whereas in the chest tube drainage group the recurrence rates were 26, 33 and 50%, respectively (P < 0.05). There was no significant difference in the recurrence rate for those receiving tetracycline compared with those who received gentamicin. CONCLUSIONS: Spontaneous pneumothorax patients who are taller, weigh less or have secondary spontaneous pneumothorax are more likely to have recurrences. The risk of recurrence is reduced in patients who undergo chemical pleurodesis. Since there was no significant difference between intrapleural tetracycline and gentamicin, gentamicin should be considered as a potential chemical sclerosing agent.     

自发性气胸的临床特点与治疗对策

目的通过对多种自发性气胸的临床表现采用不同的治疗方法,达到治愈。方法根据不同临床表现及气胸压缩程度采取人工抽气、闭式引流术、胸膜粘连术等检测效果。结论96例病人中治愈90例,说明采用适用的方法可有效地治疗自发性气胸。     

COPD合并自发性气胸12例临床误诊分析

目的提高基层医院医护人员对COPD并发自发性气胸的诊断水平,以减少误诊率。方法回顾性总结我院2000年1月～2007年1月COPD并发自发性气胸病例,并分析误诊的原因。结果本组误诊12例,误诊为COPD急性发作、哮喘急性发作、肺性脑病、急性左心衰等。误诊时间4～48h。结论对出现病情变化的COPD患者应认真进行体检,常规行胸部X线检查。从而降低COPD并发自发性气胸的误诊、漏诊率。     

不同排气方式对自发性气胸并发胸膜黏连的影响

目的 探讨自发性气胸的发生次数及不同排气方式对胸膜黏连发生率的影响.方法 对行开胸或电视胸腔镜手术治疗的特发性自发性气胸患者进行回顾性分析,根据手术前既往发生自发性气胸后所行治疗方法将患者分为未排气治疗组、胸腔穿刺抽气组和胸腔闭式引流组,观察各组患者气胸发生的次数及不同治疗方法与胸膜黏连发生率的关系.结果 3组共504例患者,未排气治疗组（91例）、胸腔穿刺抽气组（58例）和胸腔闭式引流组（355例）的胸膜黏连发生率分别为48.35％、65.52％和78.03％,胸膜黏连发生率依次升高（x^2=32.172,P＜0.05）.在未排气治疗组患者中,既往患自发性气胸1次（45例）、2次（26例）及≥3次（20例）者,胸膜黏连的发生率分别为37.78％、46.15％和75.00％,随气胸发生次数的增加而增加（x^2=7.752,P＜0.05）.胸腔穿刺抽气组患者既往行穿刺抽气治疗1次（42例）和2次（16例）者,胸膜黏连的发生率分别为59.52％、93.75％.胸腔闭式引流组患者既往行引流治疗1次（191例）、2次（108例）及≥3次（56例）者,胸膜黏连的发生率分别为71.20％、81.48％和94.64％,胸膜黏连的发生率随胸腔穿刺抽气及胸腔闭式引流次数的增加而增加,差异具有统计学意义（P＜0.05）.结论 对于自发性气胸患者行胸腔穿刺抽气或胸腔闭式引流术,会显著增加胸膜黏连的发生,且随气胸发生次数、穿刺或闭式引流次数的增加,胸膜黏连的发生率显著增加,从而增加复发性气胸的治疗难度及出现各种并发症的风险.     

自身血胸膜粘连术治疗重度慢性阻塞性肺病并自发性气胸的疗效观察

目的 比较重度慢性阻塞性肺病（COPD）并自发性气胸患者自身血胸腔内注射胸膜粘连术与滑石粉胸膜粘连术的疗效、安全性及对肺功能的影响.方法 将53例COPD并自发性气胸患者随机分为两组,试验组28例,采用自身肘静脉血50ml胸腔内注射;对照组25例,应用滑石粉混悬剂100 ml胸腔内注射.比较两组的疗效、近期不良反应、1年内的复发率及对肺功能影响.结果 试验组1例在术后出现有胸部疼痛,对照组7例在术后有胸痛或是发热.试验组与对照组在随访期间分别有4例、5例同侧气胸复发,分别有3例、5例死亡.术后1年复查肺功能较前均有下降.两组复发率及死亡率比较差异无统计学意义（P＞0.05）.结论 自身血胸膜粘连术可以有效治疗重度COPD并自发性气胸,减少不良反应发生率,预防复发并且对肺功能无明显影响.     

手术治疗自发性气胸318例

目的:分析手术治疗自发性气胸的临床效果。方法:总结手术治疗的自发性气胸318例,对气胸病因、手术疗效、结果随访及不同手术方法的比较等临床资料进行回顾性分析。结果:318例患者无手术及术后死亡,均顺利恢复出院,并发症发生率及复发率低。其中胸腔镜手术患者在手术时间、术后恢复方面优于其他术式。胸膜下肺大疱为本组手术病例的主要病因。结论:手术治疗自发性气胸安全有效。胸腔镜手术创伤小、手术时间短、术后恢复快,为自发性气胸外科治疗的首选方法。     

重组人生长激素对慢性阻塞性肺疾病营养不良患者并发气胸的治疗研究

目的 探索重组人生长激素治疗慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)营养不良患者并发气胸的临床应用价值.方法 选取COPD营养不良患者并发气胸需行胸腔闭式引流术治疗的患者58例,随机分为对照组28例,治疗组30例.两组患者均予胸腔闭式引流术、氧疗、抗感染及...     

Video-assisted thoracoscopic surgery for postoperative recurrent primary spontaneous pneumothorax

Objectives

Postoperative recurrent primary spontaneous pneumothorax (PSP) is a troublesome complication and an important issue to be discussed. This study is to determine whether Re-video assisted thoracoscopic surgery (VATS) should be performed for postoperative recurrent PSP (PORP).

Materials and methods

Patients who had underwent needlescopic VATS for PSP between Jan. 2007 and Dec. 2011 were reviewed.

Results

VATS was initially performed on 239 patients with PSP in total. Eleven patients were found to have PORP during a follow-up period of 36.95 months. Nine patients received Re-VATS and only two patients receiving conservative treatment had no further recurrence. No conversion to thoracotomy, blood transfusion and prolong air leak were recorded.

Conclusions

Even for smaller size cases, Re-VATS, which is technically feasible, safe and effective with better cosmetics and minor postoperative pain, should be a strong contender as priority treatment.     

A retrospective comparison between digital to conventional drainage systems for secondary spontaneous pneumothorax related to diffuse interstitial lung disease

Introduction

Secondary spontaneous pneumothorax (SSP) occurs as one of the complications associated with interstitial pneumonia (IP). Chest drainage is performed when there is a large volume of air in the pleural space. Notably, SSP with IP (SSP-IP) is frequently not curable by chest drainage only. A digital drainage system (DDS) provides an objective evaluation of air leakage and maintains a pre-determined negative pressure, compared to an analog drainage system (ADS). Few studies have reported the effectiveness of DDS in the treatment of SSP-IP. This study aimed to assess the usefulness of DDS for SSP-IP.

Methods

This retrospective study included patients with SSP-IP who had undergone chest drainage. We reviewed the included patients' medical records, laboratory data, computed tomography findings, and pulmonary function data.

Results

DDS was used in 24 patients and ADS in 49 patients. The mean duration of chest drainage was 11.4 ± 1.9 days in the DDS group and 14.2 ± 1.3 days in the ADS group, which was not significantly different (p = 0.218). Surgery, pleurodesis, and/or factor XIII administration were performed in 40 patients. Additionally, five (20.8%) patients in the DDS group and nine (18.4%) in the ADS group had a recurrence of pneumothorax within 4 weeks (p = 1.000). One patient (14%) in the DDS group and six (12.2%) in the ADS group (p = 0.414) were cured of pneumothorax but later died.

Conclusion

DDS did not demonstrate a significant difference in the shortening of chest drainage duration. Further study is needed to validate the results of this study.     

COPD并发自发性气胸72例诊疗体会

目的探讨COPD并发自发性气胸的临床特点、治疗方法。方法对我院近5年来收治的72例COPD并发自发性气胸患者的发病情况、临床表现、辅助检查结果及治疗方法、结果进行分析。结果 COPD并发自发性气胸患者插管率高,但复发率高。结论 COPD并发自发性气胸患者尽早行胸腔闭式引流术,可明显缩短住院时间,缓解者症状,但根治需外科手术。     

肺结核患者并发局限性气胸34例临床分析

目的：观察肺结核患者并发局限性气胸的临床特点及治疗。方法：分析此类患者的临床表现及治疗体会。结果：此类患者具有病情危重。进展快，易出现Ⅰ型呼吸衰竭等特点。结论：快速诊断、及时穿刺抽气或闭式引流术是救治张力性气胸合并呼吸衰竭患者的关键。     

Spontaneous pneumothorax as a complication of chronic Jet propulsion fuel-8 exposure

Jet Propulsion Fuel 8 (JP-8) is a kerosene based fuel commonly used in aviation. Occupational exposure to JP-8 may lead to negative health outcomes, which were described in a small number of studies. We report a case of 33-year-old Caucasian male veteran with a history of JP-8 exposure who presented with chronic dyspnea and recurrent spontaneous pneumothorax. To our knowledge, this is the first case of chronic inhalation injury from JP-8 exposure complicated with recurrent secondary spontaneous pneumothorax.     

Spontaneous pneumothorax: time for some fresh air

Conventional teaching on the mechanisms and treatment of spontaneous pneumothorax is either obviously wrong or based on a misunderstanding of the natural history of the condition. Spontaneous pneumothorax is a generally benign, self‐limiting condition where conservative management should be considered. If intervention is needed, medical thoracoscopy might be the procedure of choice.     

A case of malignant mesothelioma presenting with recurrent pneumothorax]

A 71-year-old man was found to have right hydropneumothorax by chest X-ray film on a regular checkup. Thoracic drainage and bullectomy by thoracoscopy did not improve the pneumothorax, so pleurodesis with OK-432 was done. Pneumothorax recurred twice, requiring thoracic drainage and pleurodesis. Although pneumothorax was treated successfully, increased pleural effusion, pleural thickening and subcutaneal tumor at the thoracic drainage suture site developed. The concentration of hyaluronic acid in the pleural fluid was very high. The histological examination of the biopsied subcutaneous tumor showed mixed type malignant pleural mesothelioma. Chemotherapy with gemcitabine and vinorelbine could not control the progression.