胸腔镜治疗原发性自发性气胸术后对侧发生气胸风险因素分析

Risk factors for contralateral recurrence of primary spontaneous pneumothorax after thoracoscopic surgery

目的分析胸腔镜手术治疗原发性自发性气胸术后对侧发生气胸的有关因素。方法 2010年12月-2013年6月,374例原发性自发性气胸术后患者,按术后对侧是否发生气胸分为未发病组和发病组,对两组临床资料进行回顾性分析,用Cox回归分析法进行多因素分析。结果患者平均随访时间为（36.24±11.31）个月。单因素分析发现,两组在既往复发情况（P=0.003）,术侧肺大疱类型（P〈0.001）以及术侧气胸部位（P=0.021）差异有统计学意义。多因素Cox回归分析发现,既往有多次复发史（HR=1.897,P=0.034）,术侧多发型肺大疱（HR=2.625,P=0.003）及右侧气胸术后（HR=2.120,P=0.013）是对侧发生气胸的独立风险因素。结论既往有多次气胸复发史,术侧为多发型肺大疱及右侧气胸术后的患者更易发生对侧气胸。

Objective To investigate the influence factors associated with contralateral recurrence of primary spontaneous pneumothorax（ PSP） after thoracoscope surgery. Methods From December 2010 to June 2013,374 patients with PSP were reviewed and evaluated. According to whether postoperative contralateral recurrence,they were divided into nonrecurrence group and recurrence group. The clinical features and treatment of two groups were analyzed retrospectively. The Cox regression was used to identify the independent influence factors of postoperative contralateral recurrence. Results The average follow-up time of all patient was（ 36. 24± 11. 31） months. Univariate analysis found that there were significant difference in history of recurrent（ P = 0. 003）,bulla type of operation side（ P〈0. 001） and pneumothorax position of operation between the two groups. Multivariate Cox regression analysis found that repeatedly recurrent pneumothorax of past（ HR = 1. 897,P = 0. 034）,multiple bulla of operation side（ HR= 2. 625,P = 0. 003）,and the right side pneumothorax after surgery（ HR = 2. 120,P =0. 013） were independent risk factors for contralateral recurrence. Conclusion Contralateral recurrence of PSP after video assisted thoracoscopic surgery is significantly more common in patients with repeatedly recurrent pneumothorax of past,multiple bulla of operation side,and the right side pneumothorax after surgery.