Pectus Excavatum is Associated with a Higher Incidence of Primary Spontaneous Pneumothorax in a Young Population in Taiwan: A Nationwide Population-based Study

漏斗胸與原發性自發性氣胸具有相關性：台灣健保資料庫研究

黃敍愷(Hsu-Kai Huang) ； 簡戊鑑(Wu-Chien Chien) ； 鍾其祥(Chi-Hsiang Chung) ； 陳穎毅(Ying-Yi Chen) ； 李世俊(Shih-Chun Lee) ； 黃才旺(Tsai-Wang Huang)

《胸腔醫學》 34卷2期 (2019/04) Pp. 47-57

摘要

Objectives: To investigate the risk of primary spontaneous pneumothorax among patients with pectus excavatum and to evaluate whether they have a higher risk of primary spontaneous pneumothorax than the general population. Methods: Patient data from the Taiwan National Health Insurance Research Database from January 1, 2000 to December 31, 2013 were collected. A total of 1,652 patients with pectus excavatum and a retrospective matched comparison control cohort of 6,608 individuals were analyzed. Cox regression analyses were performed to determine the risk of primary spontaneous pneumothorax. Results: The cumulative incidence rate of primary spontaneous pneumothorax was 0.36% in the study group and 0.15% in the control group. Cox regression analysis with adjustment for gender, age, income, urbanization level, and geographic region revealed that pectus excavatum patients were at significantly greater risk of developing primary spontaneous pneumothorax. Conclusion: Patients with pectus excavatum have a higher risk of developing primary spontaneous pneumothorax. Surgeons should be aware of the risk of bilateral pneumothorax and carefully evaluate these patients before performing corrective surgery using the Nuss procedure.

關鍵字

pectus excavatum ； spontaneous pneumothorax ； funnel chest

並列摘要

漏斗胸（ICD-9-CM 754.81）是否較一般族群更容易增加自發性氣胸（ICD-9-CM 512.0 + ICD-9-CM 512.8）的風險。臨床上偶而有男性瘦高病人因自發性氣胸來診發現有漏斗胸情形，或是因為漏斗胸來診於電腦斷層中發現異常肺泡組織（可能導致原發性自發性氣胸），以百萬歸人檔處理，希望可以看到其意義。使用百萬歸人檔做回溯性分析，並以一比四做配對，可找出漏斗胸組1,652人及一般組6,608人，並使用迴歸分析來判斷發生自發性氣胸之風險。結果：在累積自發性氣胸之發生率，可發現漏斗胸組為0.36%大於一般組的0.15%，經過調整性別，年齡，投保級距及居住地都市化程度後，發現漏斗胸組別有較高風險發生自發性氣胸（Hazard ratio: 7.83, 95% CI 2.114-29.004, p=0.002）。結論：漏斗胸族群與自發性氣胸之族群有高相關性，由於以納式微創矯正術治療可能導致雙側肋膜腔交通，若發生氣胸可能造成嚴重且致命的雙側氣胸，外科醫師在術前評估時，應考量有無原發性自發性氣胸的危險因素如斷層掃描發現異常肺泡等再行手術。

並列關鍵字

漏斗胸 ； 自發性氣胸