CAJ | 학술논문

目的：探讨首次发作的原发自发性气胸最佳治疗方案。方法分析我院2008年1月－2011年1月期间首次发作的原发自发性气胸患者76例，其中保守治疗组共42例，VATS 手术组共34例。比较二组患者临床特征及治疗的指标。结果二组患者中性别、年龄、气胸部位及吸烟均无统计学差异，保守治疗无效而行 VATS 手术者14例（33．3％），其中肺部持续漏气9例（21．4％），肺膨胀不全5例（11．9％）。VATS 组气胸的范围（56．91±15．52）％，与保守治疗组（48．57±19．36）％比较差异有统计学意义（P ＝0．045）。VATS 组无中转开胸，二组中均未出现肺炎、脓胸、血胸等并发症。行 VATS 手术患者，术中发现明确肺大疱共30例（88．2％），VATS 组与保守治疗组在止痛药的应用时间[（3．35±0．65）d vs （1．04±0．89）d，P ＜0．05]及拔除胸引管的时间[（4．82±0．58）d vs （4．09±0．76）d，P ＜0．05]方面比较差异有统计学意义。经过平均28．4个月的随访， VATS 组与保守治疗组气胸的复发[1例（2．9％）vs 16例（38．1％），P ＜0．05]。平均住院日期 VATS组与保守治疗组[（7．74±0．86）d vs （5．29±1．04）d，P ＜0．05]。结论与保守治疗相比，VATS 能明显降低首次发作的自发性气胸复发率，在特定的患者中，该术式值得推荐。
목적：탐토수차발작적원발자발성기흉최가치료방안。방법분석아원2008년1월－2011년1월기간수차발작적원발자발성기흉환자76례，기중보수치료조공42례，VATS 수술조공34례。비교이조환자림상특정급치료적지표。결과이조환자중성별、년령、기흉부위급흡연균무통계학차이，보수치료무효이행 VATS 수술자14례（33．3％），기중폐부지속루기9례（21．4％），폐팽창불전5례（11．9％）。VATS 조기흉적범위（56．91±15．52）％，여보수치료조（48．57±19．36）％비교차이유통계학의의（P ＝0．045）。VATS 조무중전개흉，이조중균미출현폐염、농흉、혈흉등병발증。행 VATS 수술환자，술중발현명학폐대포공30례（88．2％），VATS 조여보수치료조재지통약적응용시간[（3．35±0．65）d vs （1．04±0．89）d，P ＜0．05]급발제흉인관적시간[（4．82±0．58）d vs （4．09±0．76）d，P ＜0．05]방면비교차이유통계학의의。경과평균28．4개월적수방， VATS 조여보수치료조기흉적복발[1례（2．9％）vs 16례（38．1％），P ＜0．05]。평균주원일기 VATS조여보수치료조[（7．74±0．86）d vs （5．29±1．04）d，P ＜0．05]。결론여보수치료상비，VATS 능명현강저수차발작적자발성기흉복발솔，재특정적환자중，해술식치득추천。
Objective To evaluate whether VATS is justified at first-episode primary spontaneous pneumothorax (PSP).Methods We retrospectively reviewed 76 patients with first-episode primary spontaneous pneumothorax who underwent conservative treatment group (42 ) or VATS group (34 ) respectively from Jan.2008 to Dec.2011.We collected characteristics of patients data and outcome data. Results The differences in the age,gender,smoking and position of episode did not reach statistical significance between the two groups.Fourteen patients were performed VATS due to persistent air leakage (9,21.4%)or pneumothoraces that failed to resolve (5,11.9%)after conservative treatment.The size of pneumothorax measured (56.91 ±15.52)% in VATS group were higher than the conservative treatment group (48.57 ±19.36)%,P =0.045.No conversion to open thoracotomy was required in VATS group. There were not complications of pneumonia,empyema and hemothorax.Thirty patients (88.2%)were admitted had blebs/bullaes in the procedure,patients in the VATS group had a longer duration of pleural drainage [(3.35 ±0.65)d vs (1.04 ±0.89)d,P <0.05], a greater amount of painkiller used [(3.35 ±0.65)d vs (1.04 ±0.89)d,P =0.025]compared with conservative treatment group.After a mean follow-up of 28.4 months,the recurrence rate of ipsilateral pneumothorax was significantly higher in the conservative treatment group than the VATS group (2.9% vs 38.1%,P <0.05).Duration of hospital stay in VATS group were (7.74 ±0.86)d and (5.29 ±1.04)d in conservative treatment group (P <0.05),respectively.Conclusion Since VATS decrease the rate of recurrence of PSP dramatically compared to conservative management,it can be a useful approach in selected cases with first-episode PSP.