不同排气方式对自发性气胸并发胸膜黏连的影响

Effects of different exhaust modes on spontaneous pneumothorax with pleural adhesion

目的 探讨自发性气胸的发生次数及不同排气方式对胸膜黏连发生率的影响.方法 对行开胸或电视胸腔镜手术治疗的特发性自发性气胸患者进行回顾性分析,根据手术前既往发生自发性气胸后所行治疗方法将患者分为未排气治疗组、胸腔穿刺抽气组和胸腔闭式引流组,观察各组患者气胸发生的次数及不同治疗方法与胸膜黏连发生率的关系.结果 3组共504例患者,未排气治疗组（91例）、胸腔穿刺抽气组（58例）和胸腔闭式引流组（355例）的胸膜黏连发生率分别为48.35％、65.52％和78.03％,胸膜黏连发生率依次升高（x^2=32.172,P＜0.05）.在未排气治疗组患者中,既往患自发性气胸1次（45例）、2次（26例）及≥3次（20例）者,胸膜黏连的发生率分别为37.78％、46.15％和75.00％,随气胸发生次数的增加而增加（x^2=7.752,P＜0.05）.胸腔穿刺抽气组患者既往行穿刺抽气治疗1次（42例）和2次（16例）者,胸膜黏连的发生率分别为59.52％、93.75％.胸腔闭式引流组患者既往行引流治疗1次（191例）、2次（108例）及≥3次（56例）者,胸膜黏连的发生率分别为71.20％、81.48％和94.64％,胸膜黏连的发生率随胸腔穿刺抽气及胸腔闭式引流次数的增加而增加,差异具有统计学意义（P＜0.05）.结论 对于自发性气胸患者行胸腔穿刺抽气或胸腔闭式引流术,会显著增加胸膜黏连的发生,且随气胸发生次数、穿刺或闭式引流次数的增加,胸膜黏连的发生率显著增加,从而增加复发性气胸的治疗难度及出现各种并发症的风险.

Objective To investigate the effects of the frequency of spontaneous pneumothorax and different exhaust modes on the incidence of pleural adhesion.Methods Thoracic or video-assisted thoracic surgery treatments of idiopathic spontaneous pneumothorax were analyzed retrospectively.According to the previous treatments of the spontaneous pneumothorax before surgery,the patients were divided into three groups：non-exhaust air group,thoracentesis degassing group,and closed thoracic drainage group.The relationship of occurrence of pleural adhesion with the frequency of spontaneous pneumothorax and different treatments was observed.Results Of a total of 504 patients in the three groups,the incidence of pleural adhesion in non-exhaust air group （n =91）,thoracentesis degassing group （n =58）,and closed thoracic drainage group （n =355） was 48.35 %,65.52 %,and 78.03 %,respectively,showing successive increase （x^2=32.172,P 〈0.05）.In the non-exhaust air group,for patients who had suffered from spontaneous pneumothorax once （n =45）,twice （n =26）,and no less than three times （n =20）,the incidence of pleural adhesion was 37.78%,46.15%,and 75.00%,respectively,showing the incidence of pleural adhesion increased as the frequency of spontaneous pneumothorax increased （x^2 =7.752,P 〈 0.05）.In the thoracentesis degassing group,for patients operated thoracentesis degassing once （n =42） and twice （n =16）,the incidence of pleural adhesion was 59.52% and 93.75%,respectively.In the closed thoracic drainage group,for patients operated the closed thoracic drainage once （n =191）,twice （n =108）,and no less than three times （n =56）,the incidence of pleural adhesion was 71.20%,81.48%,and 94.64%,respectively.The incidence of pleural adhesion increased as the frequency of thoracentesis degassing and closed thoracic drainage increased （P 〈0.05）.Conclusions High recurrence rate of pleural adhesion is due to thoracentesis degassing and closed thoracic drainage for the treatment of spontaneous pneumothorax.The higher recurrence rate of pneumothorax coupled with higher frequency of traumatic air drainage therapy,the higher incidence of pleural adhesion,leading to difficulty in treating recurrent pneumothorax and higher risks of medical complications.