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, 刘占峰. 自发性气胸应用胸腔镜治疗体会. 中国民族医药, 2009, 4(1):77-79.
2.	杨立民, 杨达宽, 胡旭东. 胸腔镜下用电灼肺大疱的疗效观察.云南医药, 1999, 20s:76-77.
3.	孙林, 吴骏, 王立杰, 等. 电视胸腔镜治疗自发性气胸61例. 中国微创外科杂志, 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.	胡旭东, 王惠华, 彭荣宗, 等. 自发性气胸治疗结果的临床观察.中国胸心血管外科临床杂志, 1995, 2(2):92-93.
6.	顾恺时, 主编. 胸心外科手术学. 上海:上海科学技术出版社,2003. 499-500.
7.	刘伦旭, 周清华, 陈桂枝, 等. 青年自发性气胸、血气胸的临床分析. 中国胸心血管外科临床杂志, 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, Häussinger 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, 主编. 胸腔镜和纵膈镜手术图谱. 北京:人民卫生出版社,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.	张志庸, 徐乐天, 主编. 协和胸外科学. 第2版. 北京:科学出版社, 2010. 296.
13.	何昌进, 陈学春, 叶辉, 等. 电视胸腔镜辅助小切口配合超声刀治疗自发性气胸40例. 福建医药杂志, 2010, 32(6):13-14.
14.	周波, 聂军, 杨卫东, 等. 胸腔镜腔内切割缝合器与腔镜下缝扎术治疗自发性气胸的效果比较. 中华肺部疾病杂志:电子版, 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. 自发性气胸行电视胸腔镜手术后复发的相关因素. 中华胸心血管外科杂志, 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, 刘占峰. 自发性气胸应用胸腔镜治疗体会. 中国民族医药, 2009, 4(1):77-79.
2. 杨立民, 杨达宽, 胡旭东. 胸腔镜下用电灼肺大疱的疗效观察.云南医药, 1999, 20s:76-77.
3. 孙林, 吴骏, 王立杰, 等. 电视胸腔镜治疗自发性气胸61例. 中国微创外科杂志, 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. 胡旭东, 王惠华, 彭荣宗, 等. 自发性气胸治疗结果的临床观察.中国胸心血管外科临床杂志, 1995, 2(2):92-93.
6. 顾恺时, 主编. 胸心外科手术学. 上海:上海科学技术出版社,2003. 499-500.
7. 刘伦旭, 周清华, 陈桂枝, 等. 青年自发性气胸、血气胸的临床分析. 中国胸心血管外科临床杂志, 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, Häussinger 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, 主编. 胸腔镜和纵膈镜手术图谱. 北京:人民卫生出版社,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. 张志庸, 徐乐天, 主编. 协和胸外科学. 第2版. 北京:科学出版社, 2010. 296.
13. 何昌进, 陈学春, 叶辉, 等. 电视胸腔镜辅助小切口配合超声刀治疗自发性气胸40例. 福建医药杂志, 2010, 32(6):13-14.
14. 周波, 聂军, 杨卫东, 等. 胸腔镜腔内切割缝合器与腔镜下缝扎术治疗自发性气胸的效果比较. 中华肺部疾病杂志:电子版, 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. 自发性气胸行电视胸腔镜手术后复发的相关因素. 中华胸心血管外科杂志, 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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