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目的探讨自发性气胸临床特点、手术指征、方法及疗效。方法回顾性分析2004年4月-2010年4月自发性气胸患者163例,其中47例行胸腔闭式引流术治疗无效,改行进胸手术治疗,全部治愈;其中传统开胸手术治疗27例,胸腔镜辅助小切口(3～5cm)8例,单纯胸腔镜手术12例,并都同期行胸膜固定术(干纱布擦拭壁胸膜)。结果手术均顺利,其中6例术后持续漏气(均为慢支肺气肿继发气胸),再次开胸1例(常规开胸慢阻肺患者),其余5例以负压吸引及甲醛熏蒸后痊愈;2例术后出现包裹性胸腔积液,穿刺抽液治愈;1例术后合并有支气管哮喘术后死于哮喘持续状态。结论复发性气胸应积极予以外科手术治疗,外科手术治疗自发性气胸可靠有效;胸腔镜手术较传统开胸手术术恢复快、损伤小,但费用较高。
Objective To investigate the clinical features, surgical indications, methods and efficacy of spontaneous pneumothorax. Methods From April 2004 to April 2010, 163 patients with spontaneous pneumothorax were retrospectively analyzed. Of them, 47 patients underwent closed thoracic drainage without effective treatment and all were cured. Among them, 27 were treated by traditional thoracotomy, Thoracoscopic assisted small incision (3 ~ 5cm) in 8 cases, simple thoracoscopic surgery in 12 cases, and all at the same time line pleurodesis (dry gauze wipe the wall pleura). Results All the operations were successful. Six cases were continuously gas leaked after operation (both of them were pneumothorax secondary to COPD), one case of thoracotomy again (conventional thoracotomy patients with COPD) and the other five cases were induced by negative pressure and formaldehyde Fumigation cured; 2 cases of paroxysmal pleural effusion, puncture fluid cure; 1 case of postoperative bronchial asthma died of asthma after the continuous state. Conclusions The recurrent pneumothorax should be actively treated with surgery. Surgical treatment of spontaneous pneumothorax is reliable and effective. Thoracoscopic surgery is faster and less invasive than conventional thoracotomy, but costly.