Efficiency of video-assisted thoracic surgery for primary and secondary spontaneous pneumothorax
Efficiency of video-assisted thoracic surgery for primary and secondary spontaneous pneumothorax
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DOI：
10.1016/s0003-4975(97)01128-4
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发表时间：
1998-02-01
影响因子：
4.6
通讯作者：
Thetter, O
中科院分区：
文献类型：
--
作者：
Passlick, B;Born, C;Thetter, O
背景本研究的目的是分析电视胸腔镜手术（VATS）治疗原发性（PSP）或继发性（SSP）自发性气胸的效率，在最初的系列99例患者。从1992年4月至1995年12月，74名男性和25名女性，中位年龄为31岁（范围，17至85岁），采用VATS治疗持续性（n = 40）或复发性（n = 59）PSP（n = 65）或SSP（n = 34）。比较1988年1月至1991年12月间100例侧开胸手术患者术后镇痛药使用、住院时间和引流时间。6例（9.2%）PSP患者和10例（29.4%）SSP患者需要转为侧开胸术，大多数情况下是因为粘连。术后并发症PSP组1例（1.7%），SSP组6例（25%）。无手术死亡。中位随访29个月后，发现4例（4.8%）复发。所有复发均发生在PSP患者中，并且发生在我们经验的第一年。与侧开胸相比，PSP患者采用VATS治疗可显著缩短住院时间和引流时间，但SSP患者则无此效果。镇痛药的使用在所有接受VATS治疗的患者中均减少，与气胸类型无关。在PSP患者中，VATS手术治疗是侧开胸术的一种可行的替代方法。电视胸腔镜手术在SSP患者中的有效性仍有待确定。
Background. The objective of the study was to analyze the efficiency of video-assisted thoracic surgery (VATS) for the treatment of primary (PSP) or secondary (SSP) spontaneous pneumothorax in an initial series of 99 patients.Methods. From April 1992 to December 1995, 74 men and 25 women with a median age of 31 years (range, 17 to 85 years) were treated by VATS for persistent (n = 40) or recurrent (n = 59) PSP (n = 65) or SSP (n = 34). Postoperative parameters such as use of analgesics, length of hospital stay, and duration of drainage were compared with those of a control group of 100 patients treated by lateral thoracotomy between January 1988 and December 1991.Results. Conversion to lateral thoracotomy was necessary in 6 (9.2%) patients with PSP and in 10 (29.4%) patients with SSP, in most cases because of adhesions. Postoperative complications occurred in 1 (1.7%) patient with PSP and in 6 (25%) patients with SSP. There were no operative deaths. After a median follow-up period of 29 months, 4 (4.8%) recurrences were noted. All recurrences occurred in patients with PSP and during the first year of our experience. Compared with lateral thoracotomy, treatment by VATS resulted in a significantly shorter hospital stay and drainage duration in patients with PSP but not in patients with SSP. The use of analgesics was reduced in all patients treated by VATS independent of the type of pneumothorax.Conclusions. Surgical treatment by VATS is a viable alternative to lateral thoracotomy in patients with PSP. The usefulness of VATS in patients with SSP remains to be defined.