CAJ | 학술논문

目的：探讨慢性阻塞性肺疾病合并自发性气胸患者的治疗方式和愈后。方法回顾分析我科2007年~2012年83例慢性阻塞性肺疾病合并自发性气胸的临床资料。结果治愈75例（占90.36%），死亡8例（占9.64%）。单纯胸腔穿刺38，行胸腔闭式引流术35例，开胸行肺大疱切除或肺漏气修补术10例。开胸或胸腔镜术后留置胸管时间4~14 d（平均4.6 d），术后漏气的8例。在保证胸管引流通畅下，给予低负压吸引，术后漏气情况7~28 d后停止。1例术后持续漏气导致广泛皮下气肿，二次开胸修补后治愈。结论慢性阻塞性肺病并发自发性气胸起病急且不典型，误诊病死率高，在治疗中，对于突发严重呼吸困难的危重患者，应急诊床旁或急诊室行胸腔闭式引流术；外科开胸或微创治疗效果确切，可有效预防气胸复发。但要把握好手术指征，术中采用防止肺创面漏气以及促进胸膜腔粘连预防气胸复发的措施，术后加强呼吸道管理是保证手术效果的关键。
목적：탐토만성조새성폐질병합병자발성기흉환자적치료방식화유후。방법회고분석아과2007년~2012년83례만성조새성폐질병합병자발성기흉적림상자료。결과치유75례（점90.36%），사망8례（점9.64%）。단순흉강천자38，행흉강폐식인류술35례，개흉행폐대포절제혹폐루기수보술10례。개흉혹흉강경술후류치흉관시간4~14 d（평균4.6 d），술후루기적8례。재보증흉관인류통창하，급여저부압흡인，술후루기정황7~28 d후정지。1례술후지속루기도치엄범피하기종，이차개흉수보후치유。결론만성조새성폐병병발자발성기흉기병급차불전형，오진병사솔고，재치료중，대우돌발엄중호흡곤난적위중환자，응급진상방혹급진실행흉강폐식인류술；외과개흉혹미창치료효과학절，가유효예방기흉복발。단요파악호수술지정，술중채용방지폐창면루기이급촉진흉막강점련예방기흉복발적조시，술후가강호흡도관리시보증수술효과적관건。
Objective It is to investigate the treatment and prognosis of the chronic obstructive pulmonary disease with spontaneous pneumothorax. Methods A retrospective analysis was conducted on 83 cases of chronic obstructive pulmonary disease with spontaneous pneumothorax clinical data from 2007 to 2012. Results All of the cases, 75 cases were cured (accounting for 90.36%), and 8 patients died (accounting for 9.64%). Simple thoracentesis in38 cases, closed thoracic drainage in 35 cases, 10 cases were treated with bullous lung resection or the neoplasty of pulmonary air leaks. After thoracotomy or thoracoscopy, the chest tube was indwelled for 4-14 days (the mean is 4.6 days). And the pulmonary air leaks had 8 cases. Ensuring the chest tube unobstructed, for 7-28 days, the pulmonary air leaks were cured by giving the low suction. Lung of one case leak air sustainedly, causing extensively subcutaneous emphysema. And the case was cured by reoperation. Conclusion Chronic obstructive pulmonary disease with spontaneous pneumothorax is atypical and easy attack. And its misdiagnosis rate and mortality are high. In the treatment, those critical patients who are seriously difficult breathing should used thoracic cavity closed drainage in the emergency room;surgical thoracotomy or minimally invasive therapy can effectively prevent the recurrence of pneumothorax. But you want to grasp the indications of the surgery;the recurrence of pneumothorax is prevented for avoiding air leakage of lung wounds and promoting pleural adhesions. Therefore, it is a key of the surgery that the respiratory tract is strengthened after the surgery.