Surgical Treatment for Primary Spontaneous Pneumothorax without Bullae: A Comparative Study of Three Procedures_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 MAJian-qiang , LIXu , YANGShao-jun , YANGLi-min , WANGXi , LINGFeng , ZHAOZhi-jing

Department of Thoracic and Cardiovascular Surgery, Second Affiliated Hospital, Kunming Medical University, Kunming 650101, P. R. China;

Corresponding?author：

MAJian-qiang, Email: mjq258@163.com

Keywords：

Primary spontaneous pneumothorax without bullae; Surgical procedures; Video-assisted thoracoscopic surgery

DOI：

10.7507/1007-4848.20150214

Video：

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Objective To explore the surgical procedures for primary spontaneous pneumothorax without bullae. Methods We retrospectively analyzed the clinical data of 52 patients with primary spontaneous pneumothorax without bullae, who underwent surgical treatment in Second Affiliated Hospital of Kunming Medical University between January 2008 and January 2013. There were 46 males and 6 females, with mean average age of 23.2±4.3 years (ranged from 16 to 34 years). According to the different methods of intraoperative surgery, all patients were divided into three groups. The patients in a group Ⅰ (n=20) underwent video-assisted thoracoscope (VATS) selective apex of low energy electric coagulation treatment. The patients in a group Ⅱ (n=21) underwent VATS lung tip part of lung resection. The patients in a group Ⅲ (n=11) received VATS resection of the pleura. The clinical effectiveness among the three groups was compared. Results Compared with other two kinds of operation schemes,the leak duration(2.61±1.89 d vs. 4.90±3.20 d vs. 5.36±2.57 d, P=0.012), postoperative chest tube drainage time (3.67±2.13 d vs. 6.00±3.73 d vs. 7.03±2.58 d, P=0.003), postoperative length of hospital stay (4.95±2.16 d vs. 7.35±3.03 d vs. 8.61±2.67 d, P=0.002) and the recurrence rate (0.0% vs. 23.1% vs. 12.5%, P=0.021) of the patients with lung tip part resection of lung tissue by VATS were significantly lower. There were no statistically significant differences in the indicators of the patients with selective apex of low energy electric coagulation by VATS and those with pleural resection by VATS (P>0.05). Conclusion Lung tip part of the lung tissue resection by VATS for primary spontaneous pneumothorax without bullae is better than VATS selective apical low energy coagulation treatment and VATS resection of the pleura both in the short and long-term efficacy.

Citation： MAJian-qiang, LIXu, YANGShao-jun, YANGLi-min, WANGXi, LINGFeng, ZHAOZhi-jing. Surgical Treatment for Primary Spontaneous Pneumothorax without Bullae: A Comparative Study of Three Procedures. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(9): 859-861. doi: 10.7507/1007-4848.20150214 Copy

1.	李更德, 胡先春, 劉占峰. 自發性氣胸應用胸腔鏡治療體會. 中國民族醫藥, 2009, 4(1):77-79.
2.	楊立民, 楊達寬, 胡旭東. 胸腔鏡下用電灼肺大皰的療效觀察.云南醫藥, 1999, 20s:76-77.
3.	孫林, 吳駿, 王立杰, 等. 電視胸腔鏡治療自發性氣胸61例. 中國微創外科雜志, 2008, 8(5):428-429.
4.	Ayed AK, AL Din HJ. The results of thoracoscopic surgery for primary spontaneous pneumothorax. Chest, 2000, 118(1):235-283.
5.	胡旭東, 王惠華, 彭榮宗, 等. 自發性氣胸治療結果的臨床觀察.中國胸心血管外科臨床雜志, 1995, 2(2):92-93.
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7.	劉倫旭, 周清華, 陳桂枝, 等. 青年自發性氣胸、血氣胸的臨床分析. 中國胸心血管外科臨床雜志, 2001, 8(2):136-137.
8.	Hatz RA, Kaps MF, Meimarakis C, et al. Long-term results after video-assisted thoracoscopic surgery for first-time and recurrent spontaneous pneumothorax. Ann Thorac Surg, 2000, 70(1):253-257.
9.	Passlick B, Born C, H?ussinger K, et al. Efficiency of videoassisted thoracic surgery for primary and secondary spontaneous pneumothorax. Ann Thorac Surg, 1998, 65(2):324-327.
10.	王俊, 主編. 胸腔鏡和縱膈鏡手術圖譜. 北京:人民衛生出版社,2003. 64.
11.	Hazama K, Akashi A, shigemura N, et al. Less invasive needle thoracoscopic laser ablation of small bullae for primary spontaneous pneumothorax. Eur J Cardiothorac Surg, 2003, 24(1):139-144.
12.	張志庸, 徐樂天, 主編. 協和胸外科學. 第2版. 北京:科學出版社, 2010. 296.
13.	何昌進, 陳學春, 葉輝, 等. 電視胸腔鏡輔助小切口配合超聲刀治療自發性氣胸40例. 福建醫藥雜志, 2010, 32(6):13-14.
14.	周波, 聶軍, 楊衛東, 等. 胸腔鏡腔內切割縫合器與腔鏡下縫扎術治療自發性氣胸的效果比較. 中華肺部疾病雜志:電子版, 2012, 5(1):60-61.
15.	Tamaki M, Oshimo K, Uyama T. Recurrence after bullectomy by video-assisted thoracic surgery for spontaneous pneumothorax in younger ages. Kyobu Geka, 2007, 60(6):445-448.
16.	Czerny M, Salat A, Fleck T, et al. Lung wedge resection improves outcome in stage I primary spontaneous pneumothorax. Ann Thorac Surg, 2004, 77(5):1802-1805.
17.	卜梁, 姜冠潮, 王俊. 自發性氣胸行電視胸腔鏡手術后復發的相關因素. 中華胸心血管外科雜志, 2007, 23(6):416.
18.	Naunheim KS, Mack MJ, Hazelrigg SR, et al. Safety and efficacy of video-assisted thoracic surgical techniques for the treatment of spontaneous pneumothorax. J Thorac Cardiovasc Surg, 1995, 109(6):1198-1203.

1. 李更德, 胡先春, 劉占峰. 自發性氣胸應用胸腔鏡治療體會. 中國民族醫藥, 2009, 4(1):77-79.
2. 楊立民, 楊達寬, 胡旭東. 胸腔鏡下用電灼肺大皰的療效觀察.云南醫藥, 1999, 20s:76-77.
3. 孫林, 吳駿, 王立杰, 等. 電視胸腔鏡治療自發性氣胸61例. 中國微創外科雜志, 2008, 8(5):428-429.
4. Ayed AK, AL Din HJ. The results of thoracoscopic surgery for primary spontaneous pneumothorax. Chest, 2000, 118(1):235-283.
5. 胡旭東, 王惠華, 彭榮宗, 等. 自發性氣胸治療結果的臨床觀察.中國胸心血管外科臨床雜志, 1995, 2(2):92-93.
6. 顧愷時, 主編. 胸心外科手術學. 上海:上海科學技術出版社,2003. 499-500.
7. 劉倫旭, 周清華, 陳桂枝, 等. 青年自發性氣胸、血氣胸的臨床分析. 中國胸心血管外科臨床雜志, 2001, 8(2):136-137.
8. Hatz RA, Kaps MF, Meimarakis C, et al. Long-term results after video-assisted thoracoscopic surgery for first-time and recurrent spontaneous pneumothorax. Ann Thorac Surg, 2000, 70(1):253-257.
9. Passlick B, Born C, H?ussinger K, et al. Efficiency of videoassisted thoracic surgery for primary and secondary spontaneous pneumothorax. Ann Thorac Surg, 1998, 65(2):324-327.
10. 王俊, 主編. 胸腔鏡和縱膈鏡手術圖譜. 北京:人民衛生出版社,2003. 64.
11. Hazama K, Akashi A, shigemura N, et al. Less invasive needle thoracoscopic laser ablation of small bullae for primary spontaneous pneumothorax. Eur J Cardiothorac Surg, 2003, 24(1):139-144.
12. 張志庸, 徐樂天, 主編. 協和胸外科學. 第2版. 北京:科學出版社, 2010. 296.
13. 何昌進, 陳學春, 葉輝, 等. 電視胸腔鏡輔助小切口配合超聲刀治療自發性氣胸40例. 福建醫藥雜志, 2010, 32(6):13-14.
14. 周波, 聶軍, 楊衛東, 等. 胸腔鏡腔內切割縫合器與腔鏡下縫扎術治療自發性氣胸的效果比較. 中華肺部疾病雜志:電子版, 2012, 5(1):60-61.
15. Tamaki M, Oshimo K, Uyama T. Recurrence after bullectomy by video-assisted thoracic surgery for spontaneous pneumothorax in younger ages. Kyobu Geka, 2007, 60(6):445-448.
16. Czerny M, Salat A, Fleck T, et al. Lung wedge resection improves outcome in stage I primary spontaneous pneumothorax. Ann Thorac Surg, 2004, 77(5):1802-1805.
17. 卜梁, 姜冠潮, 王俊. 自發性氣胸行電視胸腔鏡手術后復發的相關因素. 中華胸心血管外科雜志, 2007, 23(6):416.
18. Naunheim KS, Mack MJ, Hazelrigg SR, et al. Safety and efficacy of video-assisted thoracic surgical techniques for the treatment of spontaneous pneumothorax. J Thorac Cardiovasc Surg, 1995, 109(6):1198-1203.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical Treatment for Primary Spontaneous Pneumothorax without Bullae: A Comparative Study of Three Procedures

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