Contralateral Bullae in Patients with Unilateral Primary Recurrent Spontaneous Pneumothorax

復發性自發性氣胸患者之對側囊泡

侯振泰(Chen-Tai Hou) ； 謝坤洲(Kun-Jou Hsieh) ； 林同森(Torng-Sen Lin) ； 陳宗銘(Tsong-Ming Chen) ； 賴重佑(Chung-Yow Lai) ； 吳金燕(Chin-Yen Wu) ； 張靖苓(Ching-Ling Chang) ； 方信元(Hsing-Yuan Fang) ； 鄭清源(Ching-Yuan Cheng)

《胸腔醫學》 18卷1期 (2003/02) Pp. 15-19

摘要

前言：囊泡破裂係導致自發性氣胸之主因，過去的研究顯示囊泡大多為兩側性，而且術前放射線檢查常無法正確察覺，因此我們前瞻性地在處理氣胸的同時利用胸腔鏡來觀察對側肺部的情形。
方法：由民國89年1月至89年12月，總共有16個單側反覆性自發性氣胸的患者接受胸腔鏡肺部契狀切除及肋膜沾粘術，其後行半坐臥姿，於對側掖下劃開0.8公分之傷口，伸入0度8mm之胸腔鏡觀察對側肺部的情形。
結果：平均手術時間為80分鐘，在16個患者中有15個在患側可以發現有囊泡，而在對側有12人可以發現有囊泡、結痂及沾粘，沒有手術死亡及嚴重併發症產生，經過一年追蹤，所有患者兩側均沒有氣胸產生。
結論：利用胸腔鏡例行性檢查對側肺部是一個有效安全的方法，可以提早察覺對側肺部病灶。

關鍵字

自發性氣胸 ； 囊泡 ； 胸腔鏡

並列摘要

Purpose: Ruptured bullae and blebs always contribute to spontaneous pneumothorax. Previous reports have showed that bullae and blebs of the lung are frequently bilateral, but preoperative radiological examinations cannot detect whether the exact lesions exist or not. Herein, we prospectively observe the contralateral lung, with the intent of determining the incidence of congenital bullae or blebs in patients with unilateral primary spontaneous pneumothorax.
Method and Materials: From January 2001 to December 2001, we prospectively performed thoracoscopic bullectomy and mechanical pleurodesis in 16 patients (male:14; female: 2). During the thoracoscopic bullectomy and mechanical pleurodesis, the patients were placed in a lateral position under double-lumen intubated anesthesia. Then, patients were changed in a semi-sitting position to check the contralateral lung using a 0-degree, 8-mm thoracoscope (Karl Storz Company, Germany) positioned through a one 1-cm incision below each axilla.
Results: The average operative time was 1.4 hours (range: 45 minutes to 2.1 hours). Of these 16 patients with recurrent primary spontaneous pneumothorax, unilateral bullae or blebs were found in 15 (15/16; 93.5%), and 12 patients had abnormal lesions, including bullae, blebs, pulmonary scars and pleural adhesions (12/16; 75%) in the contralateral lung parenchyma. There was no surgical mortality or morbidity. All patients underwent a successful operation without recurrence during a one-year follow- up.
Conclusion: Routinely checking the contralateral lung parenchyma to rule out possible congenital bullae and blebs is an effective and safe procedure for patients with unilateral primary spontaneous pneumothorax.

並列關鍵字

primary spontaneous pneumothorax ； contralateral bulla ； thoracoscopy