https://scholars.lib.ntu.edu.tw/handle/123456789/561909
標題: | Management of recurrent primary spontaneous pneumothorax after thoracoscopic surgery: should observation, drainage, redo thoracoscopy, or thoracotomy be used? | 作者: | JIN-SHING CHEN HSAO-HSUN HSU SHUENN-WEN KUO PEI-MING HUANG JANG-MING LEE Lee Y.C. |
公開日期: | 2009 | 卷: | 23 | 期: | 11 | 起(迄)頁: | 2438-2444 | 來源出版物: | Surgical endoscopy | 摘要: | BACKGROUND: Video-assisted thoracoscopic surgery (VATS) is the popular method for treating primary spontaneous pneumothorax (PSP). Nevertheless, the optimal management of pneumothorax recurrence after VATS remains unclear. This study evaluated the efficacies of various treatment methods. METHODS: Between 1992 and 2008, 53 cases of recurrent ipsilateral pneumothoraces were noted after 978 VATS treatments for PSP. The primary treatments included 19 observations, 14 pleural drainages with and without sclerosis, 19 redo VATS, and one thoracotomy. The demographic data and treatment outcomes were collected through retrospective chart reviews. RESULTS: The mean interval between VATS and the first recurrence was 12.8 months. Patients who underwent observation had smaller recurrences than those who underwent pleural drainage or redo VATS. The primary failure rate was 5% (1/19) for observation, 50% (7/14) for pleural drainage, 0% (0/19) for redo VATS, and 0% (0/1) for thoracotomy. After a mean follow-up period of 36 months, the repeat recurrence rate was 63.1% (12/19) for observation, 7.1% (1/14) for pleural drainage, 0% (0/19) for redo VATS, and 0% (0/1) for thoracotomy. The mean total hospital stay was 2.5 days for observation, 8.1 days for pleural drainage, 6.6 days for redo VATS, and 15 days for thoracotomy. Finally, redo VATS was performed as the primary or salvage treatment for 34 patients. Neither conversion to thoracotomy nor blood transfusion was required for any patient. Only one patient had a repeat recurrence (2.9%, 1/34). CONCLUSIONS: Redo VATS is a feasible and less invasive alternative to thoracotomy for treating recurrent pneumothorax after VATS. In contrast, both observation and pleural drainage have high treatment failures rates and thus are not recommended. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-77955060250&doi=10.1007%2fs00464-009-0404-8&partnerID=40&md5=067af54e71e97842c82b5ec7e47d4c0d https://scholars.lib.ntu.edu.tw/handle/123456789/561909 |
ISSN: | 1432-2218 | DOI: | 10.1007/s00464-009-0404-8 | SDG/關鍵字: | adult; article; cohort analysis; comparative study; female; follow up; hospitalization; human; male; methodology; monitoring; pneumothorax; recurrent disease; reoperation; retrospective study; risk assessment; thoracoscopy; thoracotomy; total quality management; treatment failure; treatment outcome; video assisted thoracoscopic surgery; wound drainage; Adult; Cohort Studies; Drainage; Female; Follow-Up Studies; Humans; Male; Monitoring, Physiologic; Pneumothorax; Recurrence; Reoperation; Retrospective Studies; Risk Assessment; Severity of Illness Index; Thoracic Surgery, Video-Assisted; Thoracoscopy; Thoracotomy; Total Quality Management; Treatment Failure; Treatment Outcome; Young Adult |
顯示於: | 醫學系 |
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