A single institution experience using the LigaSure vessel sealing system in video-assisted thoracoscopic surgery for primary spontaneous pneumothorax

This study sought to report our 6-year experience with the LigaSure vessel sealing system（LVSS） in videoassisted thoracoscopic surgery（VATS） for primary spontaneous pneumothorax.A series of 180 consecutive patients with primary spontaneous pneumothorax were operated on in our institution from May 2005 to December 2010.Intraoperatively,large lesions（bullae or blebs） with a diameter more than 2 cm were resected by staplers,and the residual lesions were treated by LVSS.LVSS was also used to ablate the apical area when no lesions were found.Conventional apical pleural abrasion was done in all cases.All patients were successfully treated using VATS with minimal perioperative bleeding.The mean operating time was 76 minutes（range,43-160 minutes） for single-side procedures and 169 minutes（range,135-195 minutes） for bilateral procedures,the mean number of applied staples was 1.93 per patient（range,0-8 days）,the duration of drainage was 3.8 days（range,2-15 days）,and the duration of hospital stay was 5.8 days（range,3-16 days）.Postoperative complications included persistent air leak（〉 5 days） in 11 cases（6.1%） and residual pneumothorax in 6（3.3%）.None required reoperation.The mean duration of follow-up was 57 months（range,24-105 months）.Recurrence was seen in three cases（1.7%）,and all underwent another operation thereafter.None of the lesions in the relapse cases received ablation with LVSS in the first operation.LVSS can optimize VATS for primary spontaneous pneumothorax and reduces the use of single-use staples.The method is safe,easy to use,and cost-effective and produces satisfactory results.

Is There a Role for Chest Computed Tomography in Patients with Primary Spontaneous Pneumothorax?

Background: Primary spontaneous pneumothorax is a relatively common condition in young adults. Although blebs and bullae are frequently found in patients with primary spontaneous pneumothorax, they are very rarely the actual cause of the pneumothorax. Objective: To assess our experience with chest computed tomography evaluation in patients with recurrent spontaneous pneumothorax as compared to their histopathology findings. Study Design: A prospective study analysis. Materials and Methods: From January 2013 to December 2016, 38 consecutive patients with unilateral recurrent spontaneous pneumothorax underwent video-assisted thoracic surgery. Their chest computed tomography scans were reviewed and compared with their histopathology findings. Results: Thirty-six adult patients with unilateral recurrent spontaneous pneumothorax were included;their mean age was 33.9 years, and they all received video-assisted thoracic surgery and mechanical pleurodesis. Blebs or bullae were present in the chest computed tomography scans of fourteen patients (39%);of those fourteen patients, five (35.7%) had emphysematous changes in histopathology. Seventeen out of the thirty-six (47%) had no blebs or bullae in their chest computed tomography scans;of those seventeen patients, ten (59%) had emphysema like changes and seven (41%) had blebs in their histopathology studies. The remaining five patients (14%) had normal chest computed tomography scans. Conclusions: We conclude that preoperative chest computed tomography is not beneficial in every patient with recurrence of primary spontaneous pneumothorax.

Matrix Metalloproteinase-9 Promoter Polymorphism in Primary Spontaneous Pneumothorax

Primary spontaneous pneumothorax （PSP） is a common clinical problem occurring in apparently healthy subjects. However emphysema like changes （ELC） in patients with （PSP） has been demonstrated, which is associated with the degradation of extraceilular matrix （ECM）. MMP-9 has been proposed to play a role in the development of emphysema and is involved in the digestion of （ECM）. Among several polymorphic changes reported in MMP-9 regulatory region, the C-1562T polymorphism increases its promoter activity Aim of the work： To test the hypothesis that the MMP-9 C-1562T polymorphism has a role in the occurrence of PSP. Subjects and Methods： MMP-9 （C-1562T） genotypes of 104 PSP patients and 97 healthy subjects （control） were determined by the polymerase chain reaction, followed by a restriction fragment length polymorphism analysis. Results： This study showed that the genotype frequency for MMP-9 1562 C 〉 T differed significantly between healthy individuals and PSP patients, with higher T allele in MMP-9 promoter in PSP patients, and the C/T ＋ T/T genotypes significantly modified the risk of developing PSP, and were associated with increased risk for PSP. Conclusion： MMP-9-1562C/T genotype may be a potentially indicative factor for susceptibility to PSP, that is, genotypes with the T allele significantly increase the risk of development of PSP.

Analyzing the CT Features of Primary Spontaneous Pneumothorax and Its Application Value

Objective:To explore the performance characteristics of CT examination in primary spontaneous pneumothorax(PSP)and the effect of pleurodesis on patients with PSP.Methods:Sixty-four patients with PSP,who received medical care in the Affiliated Hospital of Hebei University from January 2017 to December 2021,were selected as the research subjects,of which 40 were male and 24 were female patients.All 64 patients were examined by X-ray and CT;the density,enhancement,and morphology of the pneumothorax were observed and analyzed,and the classification of pneumothorax was done.Results:The clinical analysis of 64 patients with PSP showed that the number of cases with unilateral pneumothorax was 42,accounting for 65.63%,whereas the number of cases with bilateral pneumothorax was 22,accounting for 34.37%.Among the cases of unilateral pneumothorax,the number of cases with left pneumothorax was 26,accounting for 61.90%,whereas the proportion of cases with right pneumothorax was 38.10%.When examined by CT,the diagnostic coincidence rate of 64 patients with PSP was 73.44%;using X-ray examination,the diagnostic coincidence rate of 64 patients with PSP was 92.19%.Conclusion:The detection accuracy of CT is higher than that of X-ray examination,which may improve the treatment effect in PSP,ensure the accuracy of findings,and facilitate follow-up treatment as well as the effect of postoperative analysis.

Simultaneous Bilateral Spontaneous Pneumothorax: Report of 6 Adult Patients

Background: Spontaneous pneumothorax (SP) refers to the spontaneous presence of air in the pleural sac(s) without iatrogenic or traumatic factors. The simultaneous bilateral SP (SBSP) is rare yet serious clinical condition which may pose a significant threat to patient’s life. Herein, 6 patients with SBSP managed in Sulaimaniyah Teaching Hospital (STH) over 6-year period (2006-2011) are reported with literature review. Methodology: A prospective clinical study. The diagnosis was made on clinical and radiographic grounds. The initial therapy was a bilateral tube thoracostomy (BTT) followed by chemical pleurodesis. Thoracotomy for excision of subpleural blebs or bullae and pleurectomy was performed for prolonged air leak (lasting >14 days). Results: There were 5 males (83.33%) and 1 female (16.67%) with a mean age of 34.8 years ranging between 20 and 50. All patients had presented with dyspnea and chest pain and were smokers. Three patients (50%) had primary (PSP) whereas the remaining had secondary (SSP) (chronic obstructive pulmonary disease—COPD, n = 2 and pneumonia, n = 1). None of the patients had recurrence. Unilateral thoracotomy was necessary in 5 patients (SSP, n = 3 and PSP, n = 2). Prolonged air leak was observed once postoperatively (16.7%) while mortality was nil. Conclusions: Prompt recognition of this rare yet potentially serious condition is crucial. The clinical diagnosis is straightforward with plain chest radiography being the most helpful workup. The initial therapy is via BTT followed by pleurodesis. Surgery is necessary for prolonged air leak and failure of the lung to expand.

Diagnosis and treatment of primary spontaneous pneumothorax

Primary spontaneous pneumothorax(PSP) commonly occurs in tall,thin,adolescent men.Though the pathogenesis of PSP has been gradually uncovered,there is still a lack of consensus in the diagnostic approach and treatment strategies for this disorder.Herein,the literature is reviewed concerning mechanisms and personal clinical experience with PSP.The chest computed tomography(CT) has been more commonly used than before to help understand the pathogenesis of PSP and plan further management strategies.The development of video-assisted thoracoscopic surgery(VATS) has changed the profiles of management strategies of PSP due to its minimal invasiveness and high effectiveness for patients with these diseases.

Recurrent primary spontaneous pneumothorax in a large Chinese family: a clinical and genetic investigation

Background:Primary spontaneous pneumothorax(PSP)is a common manifestation of Birt-Hogg-Dubé(BHD)syndrome,which is an autosomal dominant disorder caused by mutation of the folliculin(FLCN)gene.This study was established to investigate the mutation of the FLCN gene and the phenotype in a family with PSP.Methods:We investigated the clinical and genetic characteristics of a large Chinese family with recurrent spontaneous pneumothorax.Genetic testing was performed by Sanger sequencing of the coding exons(4-14 exons)of the FLCN gene.Results:Among ten affected members in a multi-generational PSP kindred,with a total of 18 episodes of spontaneous pneumothorax,the median age for the initial onset of pneumothorax was 42.5 years(interquartile range:28.8-57.2 years).Chest computed tomography scan of the proband showed pulmonary cysts and pneumothorax.A novel nonsense mutation(c.1273C>T)in exon 11 of FLCN gene that leads to a pre-mature stop codon(p.Gln425*)was identified in the family.The genetic analysis confirmed the diagnosis of BHD syndrome in this family in the absence of skin lesions or renal tumors.Conclusions:A novel nonsense mutation of FLCN gene was found in a large family with PSP in China.Our results expand the mutational spectrum of FLCN gene in patients with BHD syndrome.

A Chickenpox Pneumothorax: A Case Report of Pneumothorax Secondary to VZV Infection

Varicella (chickenpox) is a generalized, self-limiting viral infection that is caused by varicella zoster virus (VZV). Chickenpox commonly infects children from 2 - 8 years without severe outcomes, but is particularly severe when affecting adults.

单操作孔胸腔镜下治疗原发性自发性气胸28例

目的探讨单操作孔电视胸腔镜下治疗原发性自发性气胸的可行性和相比三孔法胸腔镜手术的优势。方法回顾分析28例原发性自发性气胸的临床资料，全部采用单操作孔电视胸腔镜手术。结果28例患者中肺大疱切除者25例，单纯胸膜摩擦者3例。手术时间20～105min，平均45min；术中出血10～120mL，平均出血40mL；术后全部顺利出院，未出现并发症；随访1～23个月，无复发病例。结论单操作孔电视胸腔镜手术显著减少了手术创伤，且具有与传统开胸手术或三孔法手术相同的疗效，应进一步推广直至作为原发性自发性气胸的标准术式。

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

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。

原发性自发性气胸的日间手术

目的 探讨日间手术治疗原发性自发性气胸的可行性。方法2012年4月～2014年5月对22例原发性自发性气胸行胸腔硬膜外麻醉（thoracicepidural anesthesia，TEA）下电视辅助胸腔镜手术（video—assistedthoracoscopicsurgery，VATS），内镜切割缝合器切除肺大疱，术后当晚患者符合出院标准立即出院。结果22例手术顺利。15例完成日间手术。术后并发症2例：肺膨胀不全伴轻度皮下气肿1例，手术切口血肿1例。22例术后随访2～30个月，平均14个月，气胸无复发，无手术相关的再次入院。结论原发性自发性气胸以日间手术方式治疗是安全有效的。

应用电视胸腔镜同期治疗双侧原发性自发性气胸

【目的】探讨电视胸腔镜手术同期治疗双侧原发性自发性气胸的可行性、效果和手术要点。【方法】回顾性分析和总结我科11例应用电视胸腔镜手术同期治疗双侧原发性自发性气胸的患者的临床资料。【结果】11例患者的手术均顺利完成,手术时间为(108.7±20.3)min,术后住院天数为(7.4±1.7)d,无术中及术后死亡病例,1例出现复张性肺水肿。术后随访6～36个月,1例术后1月出现左侧气胸复发。【结论】VATS同期治疗BPSP是安全、有效的,避免了第二次手术,值得临床推广。

非胸腔闭式引流技术在胸腔镜手术治疗原发性自发性气胸中的临床应用

目的探讨非胸腔闭式引流技术在胸腔镜手术治疗原发性自发性气胸中的临床应用效果。方法回顾性分析2015年6月至2016年10月36例胸腔镜手术治疗原发性自发性气胸患者术中采用留置深静脉管或负压吸引球的非胸腔闭式引流技术的临床资料。结果全组患者手术经过顺利,平均手术时间51min,术中平均出血量36m L,术后平均住院时间5.5d,术后平均镇痛次数0.5次,术后平均留置胸腔引流管2.9d,术后早期胸腔残余气胸发生率8%,无引流管脱落现象发生,切口均甲级愈合,均治愈出院。结论胸腔镜手术治疗原发性自发性气胸采用非胸腔闭式引流技术安全可靠,患者疼痛轻,恢复快,临床应用效果好。

两孔法与标准三孔法胸腔镜手术治疗原发性自发性气胸的比较

目的探讨两孔法胸腔镜手术在治疗原发性自发性气胸中的价值。方法分析我院127例原发性自发性气胸患者,均经胸腔镜手术治疗,其中58例采用两孔法胸腔镜手术治疗(两孔法组),69例采用标准三孔法胸腔镜手术治疗(三孔法组)。比较两组的手术时间、手术出血量、伤口长度、术后胸腔闭式引流时间、术后VAS疼痛评分、术后住院时间。结果两组患者均成功经胸腔镜完成手术,两组之间的手术时间、手术出血量、术后胸腔闭式引流时间、术后住院时间无明显差别;两孔法组伤口长度较三孔法组短,两孔法组术后VAS疼痛评分较三孔法组低。结论两孔法胸腔镜行自发性气胸手术不增加手术操作难度,且能更有效减轻患者疼痛,减少手术创伤,增加患者满意度。

18～35岁原发性自发性气胸患者首次发作后同侧复发原因分析

目的探索影响中青年患者原发性自发性气胸(primary spontaneous pneumothorax,PSP)首次发作后再次复发的因素,为该疾病的治疗选择提供参考。方法回顾性分析我院2008年6月至2013年6月年龄在18~35岁,首次发作并有完整资料PSP患者215例,随访12~72个月(38.5±18.6个月)。全组随访期间同侧复发57例(复发组),无同侧复发158例(未复发组),对比两组的各项病例资料:年龄、性别、BMI指数(kg/m^2)、吸烟习惯、首次气胸发作情况、治疗情况、复发时间、发作时CT表现等,明确复发的危险因素。结果全组215例随访期间有57例同侧复发,复发率为26.51%。复发组的年龄相对较轻(24.6±4.98 vs.26.35±5.42,P<0.05),复发组少量气胸患者的比例较低(P>0.05)。复发组含气病变(91.2%vs.71.5%,P<0.05)、肺大泡(47.4%vs.21.5%,P<0.05)的比例明显高于未复发组,多发肺大泡(31.6%vs.12.0%,P<0.05)和Ⅰ型肺大泡(26.3%vs.7.0%,P<0.05)的比例复发组明显高于未复发组,复发组胸膜粘连的比例也明显高于未复发组(29.8%vs.12.7%,P<0.05),两组在其他方面均无统计学差别。经Cox多元回归分析显示,CT显示含气病变、肺大泡、多个肺大泡、Ⅰ型肺大泡为同侧复发的危险因子(P<0.05)。结论对于18~35岁首次发作的PSP患者,同侧复发与CT所见的含气病变、肺大泡、胸膜粘连明显相关,尤其是Ⅰ型肺大泡及多发肺大泡。以上复发危险因素可作为首次PSP发作后患者是否行腔镜手术的参考。

胸膜摩擦治疗原发性自发性气胸的再认识

目的探讨电视胸腔镜肺大疱切除术后加行胸膜摩擦术对年轻原发性自发性气胸患者的必要性。方法 62例行电视胸腔镜肺大疱切除术的年轻原发性自发性气胸患者分为两组,楔形切除(WR)组和楔形切除+胸膜摩擦组(WR+PA)。结果 WR组的手术时间、术后引流量、术后拔管时间、术后住院时间均显著少于WR+PA组,两组患者复发率无显著差异。结论电视胸腔镜肺大疱切除术后加行胸膜摩擦并没有显著降低气胸的复发率。

电视胸腔镜治疗全肺不张型原发性自发性气胸

目的评价电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)治疗全肺不张型原发性自发性气胸(primary spontaneous pneumothorax,PSP)的价值。方法 2002年4月～2008年5月,对38例全肺不张型PSP均行VATS。用内镜切割缝合器(Endo-GIA)切除肺大疱(6例)或丝线结扎(32例)。结果 37例手术顺利,因胸腔粘连呈蔓状中转小切口手术1例。手术时间45～256min,(115±31)min。术中出血量30～300ml,(110±95)ml。术后并发症2例(1例术后锁骨下动脉分支小血管出血,1例脓胸,均再次VATS手术),无围术期死亡。38例术后随访2～85个月,(43.2±16.1)月,气胸无复发。结论全肺不张型PSP应积极行VATS治疗。

原发性自发性气胸的病因及治疗进展

原发性自发性气胸是临床常见的肺部急症,常见于青少年,近年来发病率明显上升,其病因及发病机制尚未明确。多数学者认为原发性自发性气胸的发病与肺大疱形成、身体发育、胸廓形状及性别等有关。文章重点讨论该病的防治及新进展。

胸腔镜下不同胸膜固定术治疗青年自发性气胸的疗效比较

目的比较胸腔镜下治疗自发性气胸2种不同胸膜固定术的临床疗效。方法选取2009年11月-2013年11月期间就诊于我院的青年自发性气胸患者共79例。其中行顶壁层胸膜切除术者42例（AP组），行胸膜摩擦术者37例（PA组）。比较两组术中情况、术后疼痛评分（VAS）、术后复发等情况。结果AP组的手术时间较PA组多，[（138．6±30．6）min vs（96．7±22．7）min，P=0．002]，在术后住院天数、术后24、48、72h内的疼痛评分等方面，两组差异无统计学意义。AP组42例中复发2例，复发率4．8％，PA组37例中复发5例，复发率13．5％。Kaplan—Meier生存函数曲线显示，两组患者治疗后无复发率逐渐降低，观察组各时间点累计无复发率始终高于对照组，差异有统计学意义（x2=4．689，P=0．03）。结论电视胸腔镜下治疗原发性自发性气胸术中，采用顶壁层胸膜切除术进行胸膜固定处理，可有效降低术后气胸复发的几率。

胸腔镜治疗多发胸膜下肺大疱自发性气胸

目的探讨在自发性气胸电视胸腔镜手术治疗过程中以结扎速处理多发胸膜下肺大疱的可行性及疗效。方法 103例在电视胸腔镜手术中探查发现多发胸膜下肺大疱的自发性气胸患者分为两组,其中Ⅰ组采用低能量电凝治疗,Ⅱ组采用结扎速处理。结果与Ⅰ组相比,Ⅱ组术后胸管留置时间显著缩短(P<0.05),两组患者手术时间、使用直线切割缝合器钉仓数目、术中出血、术后持续性肺漏气、术后住院时间以及术后复发,无明显差异(P>0.05)。结论在自发性气胸术中以结扎速处理多发散在胸膜下肺大疱疗效满意,值得推广。