ObjectiveTo explore the surgical procedures for primary spontaneous pneumothorax without bullae. MethodsWe retrospectively analyzed the clinical data of 52 patients with primary spontaneous pneumothorax without bullae, who underwent surgical treatment in Second Affiliated Hospital of Kunming Medical University between January 2008 and January 2013. There were 46 males and 6 females, with mean average age of 23.2±4.3 years (ranged from 16 to 34 years). According to the different methods of intraoperative surgery, all patients were divided into three groups. The patients in a group Ⅰ (n=20) underwent video-assisted thoracoscope (VATS) selective apex of low energy electric coagulation treatment. The patients in a group Ⅱ (n=21) underwent VATS lung tip part of lung resection. The patients in a group Ⅲ (n=11) received VATS resection of the pleura. The clinical effectiveness among the three groups was compared. ResultsCompared with other two kinds of operation schemes,the leak duration(2.61±1.89 d vs. 4.90±3.20 d vs. 5.36±2.57 d, P=0.012), postoperative chest tube drainage time (3.67±2.13 d vs. 6.00±3.73 d vs. 7.03±2.58 d, P=0.003), postoperative length of hospital stay (4.95±2.16 d vs. 7.35±3.03 d vs. 8.61±2.67 d, P=0.002) and the recurrence rate (0.0% vs. 23.1% vs. 12.5%, P=0.021) of the patients with lung tip part resection of lung tissue by VATS were significantly lower. There were no statistically significant differences in the indicators of the patients with selective apex of low energy electric coagulation by VATS and those with pleural resection by VATS (P>0.05). ConclusionLung tip part of the lung tissue resection by VATS for primary spontaneous pneumothorax without bullae is better than VATS selective apical low energy coagulation treatment and VATS resection of the pleura both in the short and long-term efficacy.
①在自发性气胸的治疗方面:目前尚无足够高质量的临床证据确定任何干预或非干预措施对自发性气胸的治疗更有效.现有2个小样本的随机对照试验(RCT)显示,胸腔闭式引流比穿刺抽气治疗气体消散更快,但穿刺抽气治疗更能减少患者痛苦和住院时间;1个小样本的随机对照试验显示,采用标准的胸腔闭式引流管或细管,两者的置管时间无差异,但对大量积气的患者,标准管的气体吸收率高于细管;另1个小样本的随机对照试验显示,在使用瓣膜单向阀或水封引流瓶方面,两者对患者的气胸吸收率无影响,但使用瓣膜单向阀更能减少患者痛苦和住院时间;在胸腔闭式引流管连接负压吸引方面,1个小样本的随机对照试验显示,是否连接负压吸引对疗效无影响.②在自发性气胸复发的预防方面:2个随机对照试验和1个非随机对照试验显示,化学性胸腔粘连术比非化学性胸腔粘连术更能减少自发性气胸的复发率,但胸腔粘连术同时也引起患者疼痛和住院时间的延长;无足够临床证据证明需在首次或自发性气胸复发时采用胸腔粘连术;无足够临床证据进行外科和化学性胸腔粘连术疗效的比较,仅有1个小样本的随机对照试验提示进行电视胸腔镜手术比直接开胸术的住院时间短,但在降低复发率方面,两者无显著性统计学差异,但由于样本量的问题,尚不排除两者问有临床意义差异.
Surgical treatment is an important treatment for spontaneous pneumothorax, which can remove the gas in the pleural cavity, relieve symptoms, promote lung recruitment, moreover, prevent future recurrence. The surgical modalities included video-assisted thoracoscopic surgery (VATS) and non VATS treatment. Nowadays, the treatment of spontaneous pneumothorax has entered a minimally invasive era. With the development of minimally invasive techniques in recent years, as the representative of minimally invasive surgery, the surgeon techniques of VATS has developed to diversity, including three-port VATS, two-port VATS, uniportal VATS, subxiphoid uniportal VATS, 3D VATS, robotic-assisted VAT and cervical uniportal VATS. Each technique has its own advantages and limitations, and individual choices should be made.
ObjectiveTo explore the safety and efficacy of the treatment of peripheral bronchopleural fistula with customized silicone plug through bronchoscope. MethodsA total of 19 patients with BPF admitted to Hunan Provincial People’s Hospital from July 2017 to May 2023 were included. Detailed medical records of the patients were collected, including etiology, fistula location, treatment methods, complications, and effective rates, to assess the safety and efficacy of customized silicone plug occlusion. ResultsThe average age of the 19 patients was 61.58 years (range from 42～84 years). The fistulas were located at the right upper lobe in 8 cases, the right middle lobe in 2 cases, the right lower lobe in 2 cases, the left upper lobe in 2 cases, and the left lower lobe in 5 cases. Causes included 9 cases after pneumonectomy, 6 cases of spontaneous pneumothorax, 1 case post Microwave Ablation Therapy for lung nodule, 1 case of advanced lung cancer under radiotherapy and chemotherapy, 1 case of candidal pneumonia, and 1 case of pulmonary tuberculosis. 15 patients were successfully occluded for the first time, 1 case failed to place the plug, and 3 cases had silicone plug dislodgement within 1 week after the procedure, with a short-term effective rate of 73.68% (14 cases). A total of 40 customized silicone plugs were placed, with an average of (2.10±0.74), and the mean diameter of the plugs used was 6.4 mm, with a range of 3 to 9 mm. Fifteen patients were recruited for long-term follow-up, with a median follow-up time of 15 months (range from 1.5 to 53 months). One patient developed a new fistula on the 45th day, who was treated with a combined small Y-type single bullet-covered stent for occlusion. One patient died of severe pneumonia 3 months postoperatively, and one died of type II respiratory failure at the 30th month, both deaths were unrelated to the interventional procedure. The long-term effective rate was 68.42% (13 cases). ConclusionPlacing customized silicone plugs through bronchoscopy can rapidly and effectively occlude peripheral BPF, with satisfactory long-term outcome.
Objective To systematically evaluate the efficacy and safety of single-port thoracoscopic surgery (SPTS) in the treatment of spontaneous pneumothorax. Methods Computer searches were conducted in PubMed, The Cochrane Library, Web of Science, EMbase, CNKI, WanFang, and the Chinese Medical Association databases to collect randomized controlled trials (RCTs) and cohort studies on the comparison of efficacy and safety of SPTS and three-port thoracoscopic surgery (TPTS) for the treatment of spontaneous pneumothorax from their inception to March 2024. The Cochrane RCT bias risk assessment tool and the Newcastle-Ottawa Scale (NOS) were used to assess the quality of RCT and cohort study, respectively. Meta-analysis was performed using RevMan 5.4.1. ResultsA total of 68 studies were included, comprising 23 RCTs and 45 cohort studies with a total of 5403 patients. The NOS scores of the cohort studies were 7-8 points. Meta-analysis results showed that compared with TPTS, SPTS had less intraoperative blood loss [SMD=−1.58, 95%CI (−1.93, −1.22), P<0.001], shorter postoperative hospital stay [SMD=−1.05, 95%CI (−1.29, −0.82), P<0.001], shorter postoperative drainage tube placement time [SMD=−0.75, 95%CI (−1.00, −0.50), P<0.001], fewer postoperative complications [OR=0.34, 95%CI (0.26, 0.45), P<0.001], fewer postoperative recurrences [OR=0.48, 95%CI (0.32, 0.72), P<0.001], and less pain at 24, 48, and 72 h postoperatively [SMD=−1.71, 95%CI (−2.13, −1.30), P<0.001; SMD=−1.70, 95%CI (−2.35, −1.06), P<0.001; SMD=−1.72, 95%CI (−2.16, −1.29), P<0.001]. Conclusion SPTS is safe and effective in the treatment of spontaneous pneumothorax with high clinical value and can be further promoted in clinical practice. Considering the limitations in the number and quality of included studies, researches with larger sample sizes and higher quality are needed to validate the above conclusions.
ObjectiveTo explore the safety, feasibility and superiority of tubeless video-assisted thoracoscopic surgery (VATS) in the treatment of spontaneous pneumothorax.MethodsWe retrospectively analyzed the clinical data of 38 patients with primary spontaneous pneumothorax treated in our hospital from February 2017 to July 2018. Tubeless bullectomy was performed in 18 patients, including 11 males and 7 females, aged 14.3±1.5 years. Twenty patients underwent conventional thoracoscopic bullae resection, including 12 males and 8 females, aged 14.5±1.7 years. The clinical effectiveness was compared.ResultsAll the 38 patients completed the operation successfully under the single-port thoracoscopy, without the transfer of intubation and secondary surgery. Operation time (67.3±13.3 min vs. 81.4±13.4 min, P=0.002), preoperative anesthesia time (14.2±2.6 min vs. 18.5±2.6 min, P=0.000), postoperative anesthesia recovery time (17.1±2.6 min vs. 26.5±5.0 min, P=0.000), visual simulation score of postoperative pain (2.3±0.9 vs. 5.2±1.0, P=0.000), postoperative activity time (1.3±0.4 d vs. 2.9±0.6 d, P=0.000), postoperative hospitalization time (2.9±0.8 d vs. 5.6±1.3 d, P=0.000), hospitalization cost (35.0±6.0 kyuan vs. 59.0±10.0 kyuan, P=0.000) were better in the control group. There was no significant difference in intraoperative blood loss (73.2±4.6 mL vs. 73.9±4.1 mL) and postoperative lung revascularization time (29.3±2.4 h vs. 29.7±2.5 h) between the two groups (P>0.05).ConclusionCompared with traditional thoracoscopic bullectomy, tubeless VATS technique is safe and reliable in the treatment of spontaneous pneumothorax, with mild pain and quick recovery, in line with the concept of fast track surgery and worthy of clinical promotion.
ObjectiveTo systematically evaluate the effects of closed drainage and simply closed drainage combined with pleurodesis in the treatment spontaneous pneumothorax. MethodsWe searched PubMed, Web of Science, The Cochrane Library, CBM, WanFang Data and CNKI from their inception to December 2nd, 2014, to collect randomized controlled trials (RCTs) of simple closed drainage versus closed drainage combined with pleurodesis in the treatment of spontaneous pneumothorax. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and evaluated the risk of bias of included studies. Then, RevMan 5.3 software was used for meta-analysis. ResultsA total of 5 RCTs including 499 patients were included. The results of meta-analysis showed that:Compared with the simple closed drainage, the closed drainage combined with pleurodesis was superior in the effective rate of recurrence spontaneous pneumothorax (OR=6.85, 95%CI 3.26 to 14.39, P<0.000 01) and the recurrence rate of primary spontaneous pneumothorax (OR=0.32, 95%CI 0.18 to 0.57, P<0.001). But there were no statistical differences in both groups in the effective rate of primary spontaneous pneumothorax (OR=1.49, 95%CI 0.71 to 3.14, P=0.29), the hospital stays of primary spontaneous pneumothorax (SMD=0.08, 95%CI -0.16 to 0.31, P=0.52), the hospital stays of recurrence spontaneous pneumothorax (SMD=-1.67, 95%CI -3.96 to 0.61, P=0.15), and the duration of drainage of primary spontaneous pneumothorax (SMD=-0.11, 95%CI 0.79 to 0.58, P=0.76). ConclusionCurrent evidence suggests that closed drainage combined with pleurodesis could improve the effective rate of recurrence spontaneous pneumothorax and decrease the recurrence rate of primary spontaneous pneumothorax. Due to limited quantity and quality of included studies, the above conclusion should be validated by more high quality studies.
Objective To systematically evaluate the efficacy and safety of Single-incision thoracoscopic surgery (SITS) and two-port video-assisted thoracoscopic surgery (2P-VATS) in the treatment of spontaneous pneumothorax. Methods The databases of CNKI, PubMed, The Cochrane Libray, Web of Science, EMbase, Wanfang and Chinese Medical Association were searched by computer. Literature on SITS treatment of spontaneous pneumothorax from the establishment of the database to March 2023. The data are processed with RevMan 5.4.1. Results Finally, 107 studies were included, including 35 RCTs, 2 cohort studies, and 70 case-control studies. Meta analysis results show that compared to 2P-VATS and three port video assisted thoracoscopic surgery (3P-VATS), SITS had a shorter surgical time [SMD=–0.53, 95%CI (–0.90, –0.16), P=0.005], less intraoperative bleeding [SMD=–1.58, 95%CI (–1.93, –1.22), P<0.000 01; SMD=–1.59, 95%CI (–2.03,–1.14), P<0.000 01], shorter postoperative hospitalization time [SMD=–1.05, 95%CI (–1.29,–0.82), P<0.000 01; SMD=–1.08, 95%CI (–1.39,–0.77), P<0.000 01], and shorter postoperative drainage (catheterization) time [SMD=–0.75, 95%CI (–1.00,–0.50), P<0.000 01; SMD=–1.23, 95%CI (–1.72,–0.75), P<0.000 01], fewer postoperative complications [OR=0.34, 95%CI (0.26,0.45), P<0.000 01; OR=0.47, 95%CI (0.33,0.68), P<0.000 1], fewer postoperative recurrences [OR=0.50, 95%CI (0.33,0.75), P=0.000 8], and lighter postoperative pain [SMD=–1.71, 95%CI (–1.98,–1.45), P<0.000 01; SMD=–2.02, 95%CI (–2.46,–1.59), P<0.000 01]. Compared with 3P-VATS, 2P-VATS had less intraoperative bleeding [SMD=–1.02, 95%CI (–1.81,–0.22), P=0.01] , shorter postoperative hospitalization time [SMD=–0.59, 95%CI (–1.11,–0.06), P=0.03], shorter postoperative drainage (catheterization) time [SMD=–0.46, 95%CI (–0.85,–0.08), P=0.02], fewer postoperative complications [OR=0.36, 95%CI (0.22,0.59), P<0.000 1] , and lighter postoperative pain [SMD=–0.80, 95%CI (–1.08,–0.53), P<0.000 01]. Conclusion SITS and 2P-VATS are an effective and safe method for the treatment of spontaneous pneumothorax and worthy of further promotion and application in clinical practice. Due to limitations in the quantity and quality of included studies, the above conclusions require more large-sample, high-quality studies to be verified.