Role of Blebs and Bullae Detected by High-Resolution Computed Tomography and Recurrent Spontaneous Pneumothorax
Role of Blebs and Bullae Detected by High-Resolution Computed Tomography and Recurrent Spontaneous Pneumothorax
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DOI：
10.1016/j.athoracsur.2012.05.073
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发表时间：
2013-01-01
影响因子：
4.6
通讯作者：
Morandi, Uliano
中科院分区：
文献类型：
--
作者：
Casali, Christian;Stefani, Alessandro;Morandi, Uliano
背景资料。预防首发自发性气胸(PSP)后的复发仍然是一个有争议的问题。基于在高分辨率计算机断层扫描(HRCT)成像中发现的水泡和大泡的存在，复发的可能性是有争议的。在一项单一机构的纵向回顾研究中，我们评估了接受胸部HRCT扫描的保守治疗的PSP患者。根据HRCT发现的复发的绝对风险值和阳性预测值和阴性预测值是主要终点。我们分析了176名患者。同侧和对侧复发率分别为44.8%和12%。复发的风险与HRCT上有无水泡或水泡，或两者都有显著相关。有或无滤过泡和大疱者同侧复发的风险分别为68.1%和6.1%(阳性预测值68.1%，阴性预测值93.9%)。有或无气泡和水泡的患者发生对侧气胸的风险分别为19%和0%(阳性预测值为19%，阴性预测值为100%)。同侧复发的风险与营养不良严重程度评分直接相关：在双侧多发病变的患者中，复发风险增加高达75%。多因素分析显示，HRCT阳性与同侧复发显著相关。首发PSP后HRCT上的气泡和大泡的出现与同侧复发或对侧气胸的发生显著相关。需要进一步的研究来验证营养不良严重程度评分在选择早期手术转诊患者时的有效性。(Ann Thorac Surg 2013；95：249-56)(C)2013年，胸外科学会
Background. The prevention of recurrence after a first episode of primary spontaneous pneumothorax (PSP) remains a debated issue. The likelihood of recurrence based on the presence of blebs and bullae detected on high-resolution computed tomography (HRCT) imaging is controversial.Methods. We evaluated patients conservatively treated for PSP who underwent chest HRCT scan in a single-institution retrospective longitudinal study. Absolute risk values and positive and negative predictive values of recurrence based on HRCT findings were the primary end points.Results. We analyzed 176 patients. Ipsilateral and contralateral recurrence developed in 44.8% and 12% of patients, respectively. The risk of recurrence was significantly related to the presence of blebs or bullae, or both, at HRCT. The risk of ipsilateral recurrence for patients with or without blebs and bullae was 68.1% and 6,1%, respectively (positive predictive value, 68.1%; negative predictive value, 93,9%). The risk of contralateral pneumothorax for patients with or without blebs and bullae was 19% and 0%, respectively (positive predictive value, 19%; negative predictive value, 100%). The risk of ipsilateral recurrence was directly related to the dystrophic severity score: recurrence risk increased by up to 75% in patients with bilateral multiple lesions. Multivariate analysis showed that a positive HRCT was significantly related to ipsilateral recurrence.Conclusions. The presence of blebs and bullae at HRCT after a first episode of PSP is significantly related to the development of an ipsilateral recurrence or a contralateral episode of pneumothorax. Further studies are needed to validate the dystrophic severity score in the selection of patients for early surgical referral. (Ann Thorac Surg 2013;95:249-56) (C) 2013 by The Society of Thoracic Surgeons