Efficacy of different surgical procedures in treatment of primary spontaneous pneumothorax_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Zhenrong , FENG Hongxiang , XIAO Fei , GUO Yongqing , LIANG Chaoyang , SHI Bin , TIAN Yanchu , SONG Zhiyi ,  LIU Deruo

Department of General Thoracic Surgery, China Japan Friendship Hospital, Beijing, 100029, P.R.China;

Corresponding author：

LIU Deruo, Email: deruoliu@vip.sina.com

Keywords：

Primary spontaneous pneumothorax; initial onset of pnuemothorax; bullectomy; pleural abrasion; recurrence

DOI：

10.7507/1007-4848.201610050

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Objective To evaluate whether surgical intervention can be performed in initial onset of primary spontaneous pneumothorax (PSP) patients and whether pleural abrasion should be performed regularly in PSP treatment. Methods The clinical data of 326 PSP patients undergoing bullectomy or bullectomy combined with pleural abrasion (BLPA) between January 2008 and December 2013 were retrospectively reviewed. There were 267 males and 59 females, with a mean age of 24 years ranging from 20 to 31 years. Results The initial onset of PSP was in 229 patients, and recurrent PSP in 115 patients. Ten patients had postoperative PSP recurrence after a mean follow-up of 47 months ranging from 1 to 95 months. For the patients with initial onset of PSP, the recurrence rate was 3.1% (7/229), and that in patients with recurrent PSP was 2.6% (3/115, P=0.82). Compared with the bullectomy group (5.8%, 7/120), recurrence rate in the BLPA group was lower (1.3%, 3/224, P=0.02). There were no mortalities or significant complications in both groups. There was significant difference in body mass index (P=0.04), intraoperative adhesion (P<0.05), operation duration (P<0.01), number of bullae (P<0.01), and bullae location (P<0.01) between bullectomy and BLPA groups. Postoperative drainage (P<0.01), air leak (P=0.01) and extubation duration (P<0.01) were significantly lower in the bullectomy group. Total cost was significantly higher in the BLPA group (P<0.01). Conclusion Surgical intervention could provide satisfactory outcomes for PSP patients. Compared with bullectomy, BLPA has much lower recurrence rate, but with more drainage, longer drainage duration and higher cost.

Citation： ZHANG Zhenrong, FENG Hongxiang, XIAO Fei, GUO Yongqing, LIANG Chaoyang, SHI Bin, TIAN Yanchu, SONG Zhiyi, LIU Deruo. Efficacy of different surgical procedures in treatment of primary spontaneous pneumothorax. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(12): 952-956. doi: 10.7507/1007-4848.201610050 Copy

1.	Melton LJ, Hepper NCG, Offord KP. Incidence of spontaneous pneumothorax in Olmsted County, Minnesota: 1950-1974. Am Rev Respir Dis, 1987, 29: 1379-1382.
2.	MacDuff A, Arnold A, Harvey J. BTS Pleural Disease Guideline Group. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax, 2010, 65(Suppl 2): ii18-ii31.
3.	Baumann MH, Strange C, Heffner JE, et al. AACP Pneumothorax Consensus Group. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest, 2001, 119: 590-602.
4.	Luh SP. Diagnosis and treatment of primary spontaneous pneumothorax. J Zhejiang Univ Sci B, 2010, 11(10): 735-744.
5.	Noppen M, Alexander P, Driesen P, et al. Manual aspiration versus chest tube drainage in first episodes of primary spontaneous pneumothorax: a multicenter, prospective, randomized pilot study. Am J Respir Crit Care Med, 2002, 165(9): 1240-1244.
6.	Ayed AK, Chandrasekaran C, Sukumar M. Aspiration versus tube drainage in primary spontaneous pneumothorax: a randomized study. Eur Respir J, 2006, 27(3): 477-482.
7.	Lippert HL, Lund O, Blegvad S, et al. Independent risk factors for cumulative recurrence rate after first spontaneous pneumothorax. Eur Respir J, 1991, 4(3): 324-331.
8.	Min X, Huang Y, Yang Y, et al. Mechanical pleurodesis does not reduce recurrence of spontaneous pneumothorax: a randomized trial. Ann Thorac Surg, 2014, 98(5): 1790-1796.
9.	Divisi D, Di Leonardo G, Crisci R. Video-assisted thoracic surgery versus pleural drainage in the management of the first episode of primary spontaneous pneumothorax. Am J Surg, 2015, 210(1): 68-73.
10.	Al-Mourgi M, Alshehri F. Video-assisted thoracoscopic surgery for the treatment of first-time spontaneous pneumothorax versus conservative treatment. Int J Health Sci (Qassim), 2015, 9(4): 428-432.
11.	Herrmann D, Klapdor B, Ewig S, et al. Initial management of primary spontaneous pneumothorax with video-assisted thoracoscopic surgery: a 10-year experience. Eur J Cardiothorac Surg, 2016, 49(3): 854-859.
12.	Chen JS, Hsu HH, Kuo SW, et al. Management of recurrent primary spontaneous pneumothorax after thoracoscopic surgery: should observation, drainage, redo thoracoscopy, or thoracotomy be used? Surg Endosc, 2009, 23(11): 2438-2444.
13.	Park JS, Han WS, Kim HK, et al. Pleural abrasion for mechanical pleurodesis in surgery for primary spontaneous pneumothorax: is it effective? Surg Laparosc Endosc Percutan Tech, 2012, 22(1): 62-64.
14.	Lee P. Primary spontaneous pneumothorax: to pleurodese or not? Lancet, 2013, 381(9874): 1252-1254.
15.	Sedrakyan A, van der Meulen J, et al. Video assisted thoracic surgery for treatment of pneumothorax and lung resections: systematic review of randomised clinical trials. BMJ, 2004, 329(7473): 1008.
16.	Al-Tarshihi MI. Comparison of the efficacy and safety of video-assisted thoracoscopic surgery with the open method for the treatment of primary spontaneous pneumothorax. Ann Thorac Med, 2008, 3(1): 9-12.
17.	Sekine Y, Miyata Y, Yamada H, et al. Video-assisted thoracoscopic surgery does not deteriorate postoperative pulmonary gas exchange in spontaneous pneumothorax patients. Eur J Cardiothorac Surg, 1999, 16(1): 48-53.
18.	Hatz RA, Kaps MF, Meimarakis G, 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.
19.	Acton V. Is pleurodesis for the treatment of primary spontaneous pneumothorax a misnomer--and if it works, does it matter? J Thorac Cardiovasc Surg, 2015, 149(1): 397-398.
20.	Kennedy L, Sahn SA. Talc pleurodesis for the treatment of pneumothorax and pleural effusion. Chest, 1994, 106(4): 1215-1222.
21.	Henry M, Arnold T, Harvey J. BTS guidelines for the management of spontaneous pneumothorax. Thorax, 2003, 58 Suppl 2: ii39-ii52.
22.	Ayed AK, Al-Din HJ. The results of thoracoscopic surgery for primary spontaneous pneumothorax. Chest, 2000, 118(1): 235-238.
23.	Chang YC, Chen CW, Huang SH, et al. Modified needlescopic video-assisted thoracic surgery for primary spontaneous pneumothorax: the long-term effects of apical pleurectomy versus pleural abrasion. Surg Endosc, 2006, 20(5): 757-762.
24.	Lang-Lazdunski L, Chapuis O, Bonnet PM, et al. Videothoracoscopic bleb excision and pleural abrasion for the treatment of primary spontaneous pneumothorax: long-term results. Ann Thorac Surg, 2003, 75(3): 960-965.
25.	Donahue DM, Wright CD, Viale G, et al. Resection of pulmonary blebs and pleurodesis for spontaneous pneumothorax. Chest, 1993, 104(6): 1767-1769.

1. Melton LJ, Hepper NCG, Offord KP. Incidence of spontaneous pneumothorax in Olmsted County, Minnesota: 1950-1974. Am Rev Respir Dis, 1987, 29: 1379-1382.
2. MacDuff A, Arnold A, Harvey J. BTS Pleural Disease Guideline Group. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax, 2010, 65(Suppl 2): ii18-ii31.
3. Baumann MH, Strange C, Heffner JE, et al. AACP Pneumothorax Consensus Group. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest, 2001, 119: 590-602.
4. Luh SP. Diagnosis and treatment of primary spontaneous pneumothorax. J Zhejiang Univ Sci B, 2010, 11(10): 735-744.
5. Noppen M, Alexander P, Driesen P, et al. Manual aspiration versus chest tube drainage in first episodes of primary spontaneous pneumothorax: a multicenter, prospective, randomized pilot study. Am J Respir Crit Care Med, 2002, 165(9): 1240-1244.
6. Ayed AK, Chandrasekaran C, Sukumar M. Aspiration versus tube drainage in primary spontaneous pneumothorax: a randomized study. Eur Respir J, 2006, 27(3): 477-482.
7. Lippert HL, Lund O, Blegvad S, et al. Independent risk factors for cumulative recurrence rate after first spontaneous pneumothorax. Eur Respir J, 1991, 4(3): 324-331.
8. Min X, Huang Y, Yang Y, et al. Mechanical pleurodesis does not reduce recurrence of spontaneous pneumothorax: a randomized trial. Ann Thorac Surg, 2014, 98(5): 1790-1796.
9. Divisi D, Di Leonardo G, Crisci R. Video-assisted thoracic surgery versus pleural drainage in the management of the first episode of primary spontaneous pneumothorax. Am J Surg, 2015, 210(1): 68-73.
10. Al-Mourgi M, Alshehri F. Video-assisted thoracoscopic surgery for the treatment of first-time spontaneous pneumothorax versus conservative treatment. Int J Health Sci (Qassim), 2015, 9(4): 428-432.
11. Herrmann D, Klapdor B, Ewig S, et al. Initial management of primary spontaneous pneumothorax with video-assisted thoracoscopic surgery: a 10-year experience. Eur J Cardiothorac Surg, 2016, 49(3): 854-859.
12. Chen JS, Hsu HH, Kuo SW, et al. Management of recurrent primary spontaneous pneumothorax after thoracoscopic surgery: should observation, drainage, redo thoracoscopy, or thoracotomy be used? Surg Endosc, 2009, 23(11): 2438-2444.
13. Park JS, Han WS, Kim HK, et al. Pleural abrasion for mechanical pleurodesis in surgery for primary spontaneous pneumothorax: is it effective? Surg Laparosc Endosc Percutan Tech, 2012, 22(1): 62-64.
14. Lee P. Primary spontaneous pneumothorax: to pleurodese or not? Lancet, 2013, 381(9874): 1252-1254.
15. Sedrakyan A, van der Meulen J, et al. Video assisted thoracic surgery for treatment of pneumothorax and lung resections: systematic review of randomised clinical trials. BMJ, 2004, 329(7473): 1008.
16. Al-Tarshihi MI. Comparison of the efficacy and safety of video-assisted thoracoscopic surgery with the open method for the treatment of primary spontaneous pneumothorax. Ann Thorac Med, 2008, 3(1): 9-12.
17. Sekine Y, Miyata Y, Yamada H, et al. Video-assisted thoracoscopic surgery does not deteriorate postoperative pulmonary gas exchange in spontaneous pneumothorax patients. Eur J Cardiothorac Surg, 1999, 16(1): 48-53.
18. Hatz RA, Kaps MF, Meimarakis G, 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.
19. Acton V. Is pleurodesis for the treatment of primary spontaneous pneumothorax a misnomer--and if it works, does it matter? J Thorac Cardiovasc Surg, 2015, 149(1): 397-398.
20. Kennedy L, Sahn SA. Talc pleurodesis for the treatment of pneumothorax and pleural effusion. Chest, 1994, 106(4): 1215-1222.
21. Henry M, Arnold T, Harvey J. BTS guidelines for the management of spontaneous pneumothorax. Thorax, 2003, 58 Suppl 2: ii39-ii52.
22. Ayed AK, Al-Din HJ. The results of thoracoscopic surgery for primary spontaneous pneumothorax. Chest, 2000, 118(1): 235-238.
23. Chang YC, Chen CW, Huang SH, et al. Modified needlescopic video-assisted thoracic surgery for primary spontaneous pneumothorax: the long-term effects of apical pleurectomy versus pleural abrasion. Surg Endosc, 2006, 20(5): 757-762.
24. Lang-Lazdunski L, Chapuis O, Bonnet PM, et al. Videothoracoscopic bleb excision and pleural abrasion for the treatment of primary spontaneous pneumothorax: long-term results. Ann Thorac Surg, 2003, 75(3): 960-965.
25. Donahue DM, Wright CD, Viale G, et al. Resection of pulmonary blebs and pleurodesis for spontaneous pneumothorax. Chest, 1993, 104(6): 1767-1769.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Efficacy of different surgical procedures in treatment of primary spontaneous pneumothorax

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