早期排气与延迟排气对原发性自发性气胸预后的影响

The Comparison of Early with Delayed Evacuation on the Prognosis of Primary Spontaneous Pneumothorax

目的:研究早期排气(发病时间小于3 d)和延迟排气治疗(发病时间大于6 d)对初发原发性自发性气胸预后的影响。方法:气胸量>20％的初发原发性自发性气胸患者随机分为早期排气组(89例)和延迟排气组(96例)。早期排气组先抽气,若无效和(或)吸气量大于3L,再行胸腔插管闭式引流,漏气长于2周者外科手术。延迟排气组待发病第7天行细管抽气,若抽气量大于3L,再胸腔插管闭式引流,2周无效者手术。观察即刻成功率、平均住院时间和随访1年的复发率。结果:延迟排气组,62例1次成功,有22例和6例分别于次日和第3天抽尽,即刻成功率93．8％,6例引流无效手术,平均住院时间3．5±5．7 d,1年内复发3例;早期排气组98例,1次成功9例,两次成功26例,即刻成功率39．3％,54例闭式引流,1周内30例有效,第2周内成功11例,总体有效率85．4％,平均住院时间8．3±6．9 d,1年内23例复发,两者比较有显著差异。结论:延迟排气治疗初发原发性气胸安全,较早期排气治疗的有效率高、复发率低、住院时间短。

Objective：To study the prognosis of primary spontaneous pneumothorax （PSP）treated by early （〈3 days） evacuation（EE） vs delayed （〉6days）evacuation （DE）. Methods ：185 patients with first episode of PSP, size 〉20%, 89 cases and 96 cases randomly located in EE and DE group respectively. In each group, first manual aspiration, if unsuccessful or aspiration 〉3 L, thereafter chest tube drainage was performed. If persistence air leak 〉 2 weeks, patients treated with surgical operation. Results： In DE group, 62 out of 96 was successful at first attempt, 22 cases and 6 cases was successful at the next day and the third day respectively, immediate success rates were 93. 8%. Mean hospital stay were 3. 5 ± 5. 7 days, recurrence rates at 1-year follow-up were 3 out of 96（3%）. In EE group, 9 out of 89 was successful at first attemp,26 was successful at second attempt, immediate success rates were 39.3%. 54 perpormed tube drainage, 30 and 11 cases were success within l week and 2 weeks respectively, total success rates were 85.4%. Mean hospital stay were 8.3± 6. 9days, recurrence rates at l-year follow- up were 23 out of 89（25.8 % ）. Conclusion： PSP treated by DE was safety. Success rates was greater, recurrence rates were lower and mean hospital stay was shorter than by EE.