经内科胸腔镜行医用胶辅助氩等离子体凝固术联合巨型肺大疱减容术治疗胸膜下肺大疱所致自发性气胸的疗效及安全性

Effectiveness and safety of medical glue assisted argon plasma coagulation union giant emphysematous bulla volume reduction via thoracoscope on the treatment of spontaneous pneumothorax with subpleural bullae

目的观察经内科胸腔镜行医用胶辅助氩等离子体凝固术(简称"APC plus")联合巨型肺大疱减容术(简称"一镜加一针")治疗高分辨率CT(HRCT)显示多发且部分直径≥4 cm的胸膜下肺大疱(SPB)所致自发性气胸(SP)患者的疗效及安全性。方法回顾性分析2018年6月至2021年12月日照市中医医院呼吸与危重症医学科采用"APC plus"联合"一镜加一针"治疗46例SP并多发且大小不等SPB(其中至少有1个SPB的直径≥4 cm)患者的临床资料,其中男42例,女4例,年龄31~79(68.5±10.3)岁。统计术后停止漏气时间、术后1周SPB消失率及缩减程度、术后2年SP复发率及近远期并发症。结果共纳入46例患者,SPB消失或接近完全消失39例(84.78%),减少或缩小5例(10.87%),无变化2例(4.35%)。40例患者1周内停止漏气,6例患者超过1周停止漏气。11例患者完成术后3年随访,13例患者完成术后2年随访,6例患者完成术后1年随访,其中1例复发。46例患者均无严重并发症发生。结论"APC plus"联合"一镜加一针"对HRCT显示多发且部分直径≥4 cm SPB的SP患者安全、有效。

Objective To evaluate the effectiveness and safety of a new treatment protocol that combined“medical glue assisted argon plasma coagulation”(hereinafter called“APC plus”)and“giant emphysematous bulla volume reduction”(hereinafter called“one thoracoscope plus one needle”)via medical thoracoscopy on the spontaneous pneumothorax patients whose chest high resolution CT(HRCT)showed multiple subpleural bullae(SPB)and at least one SPB≥4 cm in diameter.Methods A retrospective analysis was performed on the clinical data of 46 cases of spontaneous pneumothorax with multiple SPB(at least one SPB≥4 cm in diameter),42 males and 4 females,aged from 31 to 79(68.5±10.3)years,from June 2018 to December 2021 in Rizhao Hospital of Traditional Chinese Medicine.The time of air leakage discontinuance,the disappearance rate and reduction degree of target subpleural blebs one week after operation,the degree of reduction and the incidence of postoperative complications were observed.Two-year follow-up after operation was carried out to assess the recurrence rate and its short-and long-term complications.Results Among the 46 patients,SPB disappeared or nearly disappeared in 39 cases(84.78%),decreased in number or reduced in volume in 5 cases(10.87%),and remained unchanged in 2 cases(4.35%)after the intervention of“APC Plus”;40 patients stopped leaking within 1 week and 6 cases stopped leaking over a week.Eleven patients finished the 3-year follow-up,13 finished 2-year follow-up and 6 finished 1-year follow-up,with only 1 relapse.No serious complications occurred in all these 46 patients.Conclusion“APC plus”combining with“one thoracoscope plus one needle”is safe and effective in the treatment of pneumothorax patients with multiple subpleural bullae of varying sizes.