原发性气胸手术指征的探讨

Exploration on the operation indication of primary pneumothorax

目的探讨原发性气胸的手术指征.方法 回顾分析本院1998年10月至2008年4月收治的1008例原发性气胸患者的临床资料.结果 随访2年以上,首次就诊行保守治疗383例中第2次发生气胸215例（61.3%）,仍行保守治疗23例,该23例中气胸再次发生15例（65.2%）.随访2年以上腔镜手术247例,开胸手术268例,共计515例,腔镜手术术侧气胸复发12例（4.86%）,开胸手术术侧气胸复发12例（4.48%）.结论 对于保守治疗复发率明显偏高（苏南地区）的原发性气胸,应当采取比目前所认同的手术指征更为积极的手术方法,甚至对于原发性气胸首次发生的患者,手术也可作为首选的治疗措施之一.

Objective To sum up the indications of treatment about the initial attack of primary pneumothorax, through the statistics of recurrence rate and relevant operation data after the different treatments to primary pneumothorax. Methods Retrospective analysis of primary pneumothorax 1168 patients, 383 cases of were taken consevative treatment, 603 cases of initial attack of primary pneumothorax were taken surgical therapy. In which 288 cases were taken assisted thoracoseopie surgery, 315 cases were taken open thoracotomy. Results 351 cases with conservative treatment keep follow - up for more than two years, in which 215 cases suffered with the second attack （61.3%）, 12 patients （4. 86% ）with the treatment of assisted thoracoscopie surgery had recurrenc, the other 12 patients （4. 48% ） with the treatment of open thoracotomy had recurrene. Conclusions The recurrence rate （South Jiangsu） of primary pneumothorawas were obviously higher after the conservative treatment, we shall be more positive to the surgical indications than current views, even surgical treatment should be taken the preferred treatment for the primary pneumothorax first attack.