Pneumothorax in cystic fibrosis: management and outcome.
Pneumothorax in cystic fibrosis: management and outcome.
复制标题
囊性纤维化中的气胸：治疗和结果。
DOI：
10.1016/s0022-3476(82)80502-7
复制
发表时间：
1982
期刊：
影响因子：
--
通讯作者：
H. Shwachman
中科院分区：
文献类型：
--
作者：
F. J. Mclaughlin;W. J. Matthews;D. Strieder;K. Khaw;S. Schuster;H. Shwachman
我们回顾了过去12年的经验，以确定最佳的治疗方法，确定并发CF的气胸内科与外科治疗的发病率和生理结局，并评估年龄、性别和Shwachman评分对生存率的影响。65例患者，年龄范围为5 - 32岁（平均18岁），Shwachman评分范围为25 - 87（平均57），男女比例为1：1，经历了170例气胸，93例首次发作，77例复发，需要211次治疗试验。除针吸外，所有治疗方法的缓解率均为70 - 100%，但观察（60%）、针吸（79%）、套管针开胸术（63%）、四环素硬化（86%）和银硝酸盐硬化（43%）的复发率较高。奎纳克林硬化术的复发率为12.5%，壁层胸膜切除术为0%。奎纳克林硬化和壁胸膜切除术是最有效的治疗方法。气胸前与胸膜硬化或壁层胸膜切除术后肺功能无显著差异。年龄、性别、肺部疾病严重程度是影响预后的独立变量。疾病的严重程度，而不是气胸的发生，似乎是死亡的主要原因。我们建议，奎纳克林硬化应考虑管理的第一气胸，壁胸膜切除术，如果它失败了。
We reviewed our experience over the past 12 years to determine the best method of management, to determine the morbidity and the physiologic outcome of medical vs surgical treatment of pneumothorax complicating CF, and to assess the influence of age, sex, and Shwachman scores on survival. Sixty-five patients, ages ranging from 5 to 32 years (mean 18 years), Shwachman scores ranging from 25 to 87 (mean 57), and a male:female ratio of 1:1, experienced 170 pneumothoraces, 93 first episodes, and 77 recurrences, requiring 211 trials of management. All methods of management except needle aspiration resulted in a fair rate of resolution (70 to 100%), but recurrence rates were high for observation (60%), needle aspiration (79%), trocar thoracotomy (63%), tetracycline sclerosis (86%), and silver nitrate sclerosis (43%). The recurrence rates were 12.5% for quinacrine sclerosis and 0% for parietal pleurectomy. Quinacrine sclerosis and parietal pleurectomy were the most effective methods of management. There was no significant difference in pulmonary function before pneumothorax and after pleural sclerosis or parietal pleurectomy. Age, sex, and severity of pulmonary disease were all independent variables influencing prognosis. Severity of disease, rather than the occurrence of a pneumothorax, appears to be the major cause of death. We recommend that quinacrine sclerosis should be considered for management of the first pneumothorax, and parietal pleurectomy if it fails.