Lung wedge resection improves outcome in stage I primary spontaneous pneumothorax
Lung wedge resection improves outcome in stage I primary spontaneous pneumothorax
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DOI：
10.1016/j.athoracsur.2003.10.057
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发表时间：
2004-05-01
影响因子：
4.6
通讯作者：
Mueller, MR
中科院分区：
文献类型：
--
作者：
Czerny, M;Salat, A;Mueller, MR
背景评价肺尖楔形切除术与单纯胸膜尖切除术在术后无内镜异常的复发性原发性自发性气胸患者中的作用。我们对1994年1月至2001年12月期间113例I期复发性PSP患者的126例连续电视胸腔镜手术（VATS）进行了回顾性分析。采用两种手术策略：单纯心尖胸膜切除术（57例，45.2%：A组）和心尖胸膜切除联合心尖肺楔形切除术（69例，54.8%：B组）。平均胸管留置时间为1.4天（范围1 - 7天），平均住院时间为2.4天。3例患者（2.4%）需要再次VATS，A组2例（3.5%）因持续性漏气，B组1例（1.4%）因心尖血胸。平均随访38.7个月。总复发率为3.2%。A组4例患者（7%）在术后4 - 73周（平均30.2周）复发同侧气胸。B组无复发（p = 0.009）。在这组没有内镜异常的患者中，VATS的复发率较低。然而，这些数据表明，即使对于这类有利的患者，心尖胸膜切除术也应伴随心尖肺楔形切除术。
Background. To evaluate the role of apical lung wedge resection in patients with recurrent primary spontaneous pneumothorax with no endoscopic abnormalities at surgery as compared with simple apical pleurectomy.Methods. We performed a retrospective analysis on 126 consecutive video-assisted thoracoscopic surgery (VATS) procedures in 113 patients treated for stage I recurrent PSP between January 1994 and December 2001. Two surgical strategies were applied: simple apical pleurectomy (57 procedures, 45.2%: group A) and apical pleurectomy together with an apical lung wedge resection (69 procedures, 54.8%: group B).Results. Mean duration of chest tubes was 1.4 days (range, 1 to 7), mean hospital stay was 2.4 days. Three patients (2.4%) required redo VATS, 2 in group A (3.5%) for persistent air leak and 1 (1.4%) in group B for apical hematothorax. Mean follow-up was 38.7 months. Overall recurrence rate was 3.2%. Four patients in group A (7%) experienced recurrent ipsilateral pneumothoraces 4 to 73 weeks (mean, 30.2) after surgery. No recurrences were observed in group B (p = 0.009).Conclusions. In this selected group of patients without endoscopical abnormalities, VATS offers low recurrence rates. However, these data suggest that apical pleurectomy should be accompanied by apical lung wedge resection even for this favorable category of patients.