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.

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.

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.