Experiences in the Treatment of Recurrent Pneumothorax after VATS: Focusing on Operative Findings

自發性氣胸在胸腔鏡輔助手術術後復發的手術處理經驗

童詠偉(Yung-Wei Tung) ； 徐中平(Chung-Ping Hsu) ； 莊政諺(Cheng-Yen Chuang) ； 謝聖怡(Sen-Ei Shai) ； 夏君毅(Jiun-Yi Hsia) ； 楊適生(Shyh-Sheng Yang) ； 陳志毅(Chih-Yi Chen)

《胸腔醫學》 17卷3期 (2002/09) Pp. 226-231

摘要

背景 雖然胸腔鏡的發展已經使得原發性自發性氣胸的處理變得更加容易，至今仍沒有足夠的研究來探討有關胸腔鏡術後的復發率以及復發的原因。
方法 從1993年1月到2001年6月，我們一共分析了216位原發性自發性氣胸接受胸腔鏡輔助手術的病人。其中有九個復發病人接受第二次手術。資料收集主要是在於第二次手術的發現。
結果 所有病人都是男性，年齡界於15到27歲之間。有八位在第一次手術發現肺尖小泡的存在。在第二次手術中，四位存在下葉肺泡且三位存在上葉肺泡。所有的病例均未有足夠之肋膜沾粘形成。平均復發時間為8.3 個月（1 到 26個月之間）。其中有一位病人在第二次手術後仍復發。
結論 一般認為造成復發的主要原因是失敗的肋膜沾粘術以及沒有發現的小泡。在第二次手術中，藉由更廣泛的肋膜括除術和進一步的肺泡切除便能改善治療結果。

關鍵字

胸腔鏡輔助手術 ； 復發性自發性氣胸

並列摘要

Background: Although video-assisted thoracoscopic surgery (VATS) is considered to be the first choice for the management of primary spontaneous pneumothorax (PSP), the long-term recurrence rates and the causes of recurrence have not been well evaluated.
Methods: Between January 1993 and July 2001, nine of 216 patients diagnosed with primary spontaneous pneumothorax (PSP) who had received VATS, and latter had recurrent pneumothorax, were reviewed, and the operative findings were evaluated.
Results: All of the patients were male, and aged between 15 and 27 years. Apical blebs were found in all cases, except one, in the first operation. In the re-operation, four patients had blebs in the lower lobe and three patients had apical blebs in the upper lobe. All patients were found to have few or no pleural adhesions. The mean interval of recurrence was 8.3 months (1 to 26 months), and only one patient developed recurrent pneumothorax after the 2nd operation.
Conclusion: The main reasons for recurrent pneumothorax after VATS include failed pleurodesis and unidentified blebs. Better results can be achieved by performing further bleb resection and more extensive pleural abrasion in the re-operation.

並列關鍵字

video-assisted thoracoscopic surgery ； recurrent pneumothorax