Videothoracoscopic treatment of primary spontaneous pneumothorax: A 6-year experience
Videothoracoscopic treatment of primary spontaneous pneumothorax: A 6-year experience
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DOI：
10.1016/s0003-4975(99)01299-0
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发表时间：
2000-02-01
影响因子：
4.6
通讯作者：
Martelli, M
中科院分区：
文献类型：
--
作者：
Cardillo, G;Facciolo, F;Martelli, M
背景原发性自发性气胸（PSP）的治疗时机和手术入路尚未明确。本研究的目的是提出一种治疗方案，电视胸腔镜（VATS）在PSP。自1992年7月至1998年5月，432例PSP患者接受了VATS治疗。适应症包括：复发性同侧气胸：322例;首次发作后持续漏气：93例患者; VATS后复发：16例患者;开胸术后复发：1例患者。Vanderschueren分期法。手术适应症为：I期和II期，胸膜次全切除术或滑石粉填塞术; III期和IV期，吻合或结扎大疱和胸膜次全切除术或滑石粉填塞术。计算复发率的差异以比较具体的程序。无术后死亡。并发症发生率为4.16%。转化率为2.3%。平均随访38个月（2 - 72个月）。总复发率为4.4%。吻合和滑石粉填充后的特定复发率分别为1.27%和1.79%。滑石粉填塞法和吻合术治疗肺大泡的疗效分别上级胸膜次全切除术（p < 0.0001）和胸膜结扎术（p < 0.0001）。胸腔镜下吻合肺大泡和滑石粉囊是PSP的首选治疗方法。(C)2000年由胸外科医师协会出版。
Background. Timing and surgical approach in the treatment of primary spontaneous pneumothorax (PSP) are not well defined. The objective of this study is to propose a treatment protocol by videothoracoscopy (VATS) in PSP.Methods. From July 1992 to May 1998, 432 patients underwent VATS treatment of PSP. Indications were: recurrent ipsilateral pneumothorax: 322 cases; persistent air leak following a first episode: 93 patients; recurrence following VATS: 16 cases; recurrence following thoracotomy: 1 patient. Vanderschueren's classification was used for staging. Surgical indications were: stages I and II, subtotal pleurectomy or talc poudrage; stages III and IV, stapling or ligation of the bullae and subtotal pleurectomy or talc poudrage. Differences in recurrence rates were calculated to compare the specific procedures.Results. No postoperative deaths occurred. Complication rate was 4.16%. Conversion rate was 2.3%. Mean follow-up was 38 months (2 to 72 months). Overall recurrence rate was 4.4%. Specific recurrence rates following stapling and talc poudrage were, respectively, 1.27% and 1.79%. Talc poudrage and stapling of the bullae are respectively superior to subtotal pleurectomy (p < 0.0001) and ligation (p < 0.0001).Conclusions. Stapling of the bullae and talc poudrage by VATS represent the treatment of choice of PSP. (C) 2000 by The Society of Thoracic Surgeons.