- 學位論文
原發性自發性氣胸患者接受同側氣胸手術合併對側肺泡切除可有效降低對側氣胸發生率
Contralateral blebs excision in patients receiving VATS for ipsilateral primary spontaneous pneumothorax---effectively lower contralateral occurrence
摘要
目的 在原發性自發性氣胸患者的對側氣胸發生率約為15%。如果合併有對側肺泡，氣胸發生率則升高至26%。本研究目的在探討對此類氣胸患者，同時施行同側胸腔鏡氣胸手術合併對側肺泡切除是否可有效降低對側氣胸發生率。 方法 於2009年1月至2015年12月期間，共有335位原發性自發性氣胸患者接受胸腔鏡手術行肺泡切除及肋膜沾黏手術。平均追蹤期為71 ± 31個月。將其分為三組病人族群如下: group IV-cb共包含142位無對側肺泡的患者，僅接受同側氣胸手術；group IV+cb共包含123位有對側肺泡的患者，僅接受同側氣胸手術；group BV共包含70位有對側肺泡的患者，接受同側氣胸手術及對側肺泡切除手術。病人的基本資料，術前狀況，氣胸復發的型態，氣胸累積發生率，及相關危險因子都被回溯性紀錄和進一步比較分析。 結果 研究分析發現對側氣胸發生率在group IV-cb, group IV+cb, group BV三組間有顯著差異 (0.7%, 14.6%, and 2.9%; P=0.002)。以Cox比例風險模式分析結果顯示年齡小於18歲 (風險比: 2.71, 95%信賴區間: 1.14-6.44, P=0.024)以及group IV+cb (風險比: 22.13, 95%信賴區間: 2.96-165, P=0.003)為對側氣胸復發的危險因子。以Kaplan-Meier存活曲線分析得出三組間的累積發生率也有顯著差異 (P<0.0001)。 結論 原發性自發性氣胸患者施行同側手術合併對側肺泡切除可顯著降低對側氣胸發生率。
並列摘要
Objective: Contralateral occurrence in patients with primary spontaneous pneumothorax (PSP) is about 15%. If positive for blebs, the occurrence rate increases to 26%. This study is to determine whether simultaneous contralateral video-assisted thoracic surgery (VATS) blebs excision would effectively lower the contralateral incidence of pneumothorax in patients receiving surgery for ipsilateral PSP. Methods: Between January 2009 and December 2015, 335 patients with PSP, surgically treated in a single institution, were retrospectively studied. Mean follow-up is 71 ± 31 months. All patients received VATS blebectomy/bullectomy with pleural abrasions. They were classified into three groups: group IV-cb included 142 ipsilateral PSP patients without contralateral blebs/bullae, only receiving ipsilateral VATS; group IV+cb included 123 ipsilateral PSP patients with contralateral blebs/bullae only receiving ipsilateral VATS; and group BV included 70 ipsilateral PSP patients with contralateral blebs/bullae receiving one-stage bilateral VATS. Demographic data, perioperative details, recurrence patterns, cumulative recurrence rates, and risk factors were compared. Results: The percentage of contralateral occurrence for groups IV-cb, IV+cb, and BV differed significantly (0.7%, 14.6%, and 2.9%, respectively; P = 0.002). Multivariate analysis using the Cox proportional hazard model revealed age < 18 years (Hazard ratio [HR]: 2.71, 95% confidence interval [CI]: 1.14 to 6.44, P = 0.024) and group IV+cb (HR: 22.13, 95% CI: 2.96 to 165, P = 0.003) were predictors of contralateral occurrence, of which cumulative incidence was notably different among groups as determined by Kaplan-Meier analysis (P < 0.0001). Conclusions: Simultaneous contralateral blebectomy in PSP patients receiving ipsilateral VATS significantly lowered future contralateral occurrence.
參考文獻
延伸閱讀
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