慢性阻塞性肺疾病合并自发性气胸的治疗

目的探讨慢性阻塞性肺疾病合并自发性气胸患者的治疗方式和愈后。方法回顾分析我科2007年²012年83例慢性阻塞性肺疾病合并自发性气胸的临床资料。结果治愈75例(占90.36%),死亡8例(占9.64%)。单纯胸腔穿刺38,行胸腔闭式引流术35例,开胸行肺大疤切除或肺漏气修补术10例。开胸或胸腔镜术后留置胸管时间42012年83例慢性阻塞性肺疾病合并自发性气胸的临床资料。结果治愈75例(占90.36%),死亡8例(占9.64%)。单纯胸腔穿刺38,行胸腔闭式引流术35例,开胸行肺大疤切除或肺漏气修补术10例。开胸或胸腔镜术后留置胸管时间4¹4 d(平均4.6 d),术后漏气的8例。在保证胸管引流通畅下,给予低负压吸引,术后漏气情况714 d(平均4.6 d),术后漏气的8例。在保证胸管引流通畅下,给予低负压吸引,术后漏气情况7²8 d后停止。1例术后持续漏气导致广泛皮下气肿,二次开胸修补后治愈。结论慢性阻塞性肺病并发自发性气胸起病急且不典型,误诊病死率高,在治疗中,对于突发严重呼吸困难的危重患者,应急诊床旁或急诊室行胸腔闭式引流术;外科开胸或微创治疗效果确切,可有效预防气胸复发。但要把握好手术指征,术中采用防止肺创面漏气以及促进胸膜腔粘连预防气胸复发的措施,术后加强呼吸道管理是保证手术效果的关键。

The Treatment of Chronic Obstructive Pulmonary Disease with Spontaneous Pneumothorax

Objective It is to investigate the treatment and prognosis of the chronic obstructive pulmonary disease with spontaneous pneumothorax. Methods A retrospective analysis was conducted on 83 cases of chronic obstructive pulmonary disease with spontaneous pneumothorax clinical data from 2007 to 2012. Results All of the cases, 75 cases were cured （accounting for 90.36%）, and 8 patients died （accounting for 9.64%）. Simple thoracentesis in38 cases, closed thoracic drainage in 35 cases, 10 cases were treated with bullous lung resection or the neoplasty of pulmonary air leaks. After thoracotomy or thoracoscopy, the chest tube was indwelled for 4-14 days （the mean is 4.6 days）. And the pulmonary air leaks had 8 cases. Ensuring the chest tube unobstructed, for 7-28 days, the pulmonary air leaks were cured by giving the low suction. Lung of one case leak air sustainedly, causing extensively subcutaneous emphysema. And the case was cured by reoperation. Conclusion Chronic obstructive pulmonary disease with spontaneous pneumothorax is atypical and easy attack. And its misdiagnosis rate and mortality are high. In the treatment, those critical patients who are seriously difficult breathing should used thoracic cavity closed drainage in the emergency room;surgical thoracotomy or minimally invasive therapy can effectively prevent the recurrence of pneumothorax. But you want to grasp the indications of the surgery;the recurrence of pneumothorax is prevented for avoiding air leakage of lung wounds and promoting pleural adhesions. Therefore, it is a key of the surgery that the respiratory tract is strengthened after the surgery.