Efficacy and Risk Factors of Recurrence after Video-assisted Thoracoscopic Surgery for Primary Spontaneous Pneumothorax_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIHua-wei , ZHANGXing-bo , ZHAONing , XUHao , ZHAOJia-ying ,  ZHANGLin-you , GUOCong-ying

Department of Thoracic Surgery, The 2nd Affiliated Hospital of Harbin Medical University, Harbin 150086, P. R. China;

Corresponding author：

ZHANGLin-you, Email: lyzhang6666@gmail.com

Keywords：

Spontaneous pneumothorax; Double-port technique; Triple-port technique; Thoracoscope; Recurrence factor

DOI：

10.7507/1007-4848.20160166

Video：

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Objective To explore clinical efficacy and independent risk factors related to the recurrence of primary spontaneous pneumothorax (PSP) after video-assisted thoracoscopic surgery (VATS). Method We retrospectively anal- yzed the clinical data of 566 PSP patients by VATS in our hospital between December 2011 and June 2014 year. The patients were divided into a triple-port group(110 patients with 88 males and 22 females, aged 31.34±15.62 years) and a double-port group (456 patients with 383 males and 73 females, aged 31.46±15.65 years) by operation methods. We tried to find out the independent risk factors related to the recurrence. Results There was no statistical difference in intraoperative blood loss, postoperative drainage, drain removal, postoperative complications, postoperative length of hospital stay and rate of postoperative recurrence between the two groups (P>0.05) . However, the operation time (P<0.001) and the drainage of postoperative 48 hours (P<0.05) in the double-port group was shorter or less than that in the triple-port group. The overall recurrence rate was 1.41% (8/566) . The minors (OR=14.75, P=0.045) , no bulla type (OR=32.76, P=0.019) , and multiple bulla type (OR=15.48, P=0.013) were the independent risk factors for postoperative recurrence. Conclusions The double- port VATS technique has similar effect with triple-port VATS technique on spontaneous pneumothorax patients under- gone pulmonary bullae ligation and pleurodesis. Bulla ligation and whole mechanical pleurodesis can get better clinical efficacy and lower rate of recurrence. The minor, no bulla type, and multiple bulla type are the independent recurrence risk factors of PSP after surgery.

Citation： LIHua-wei, ZHANGXing-bo, ZHAONing, XUHao, ZHAOJia-ying, ZHANGLin-you, GUOCong-ying. Efficacy and Risk Factors of Recurrence after Video-assisted Thoracoscopic Surgery for Primary Spontaneous Pneumothorax. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(7): 692-697. doi: 10.7507/1007-4848.20160166 Copy

1.	Uramoto H, Shimokawa H, Tanaka F. What factors predict recurr-ence of a spontaneous pneumothorax? J Cardiothoracic Surg, 2012, 7(1) :1-5.
2.	Santill_an-Doherty P, Argote-Greene LM, Guzman-Sanchez M. Thoracoscopic management of primary spontaneous pneumothorax. Am Surg, 2006, 72(2) :145-149.
3.	Lee P. Primary spontaneous pneumothorax:to pleurodese or not? Lancet, 2013, 381(9874) :1252-1254.
4.	MacDuff A, Arnold A, Harvey J. Management of spontaneous pneumothorax:British Thoracic Society Pleural Disease Guideline. Thorax, 2010, 65(suppl 2) :ii18-ii31.
5.	Min X, Huang Y, Yang Y, et al. Mechanical pleurodesis does not reduce recurrence of spontaneous pneumothorax:a randomized trial. Ann Thorac Surg, 2014, 98(5) :1790-1796.
6.	De Vos B, Hendriks J, Van Schil P, et al. Long-term results after video-assisted thoracic surgery for spontaneous pneumothorax. Acta Chir Belg, 2002, 102(6) :439-444.
7.	Passlick B, Born C, Haussinger K, et al. Efficiency of video-assisted thoracic surgery for primary and secondary spontaneous pneumothorax. Ann Thorac Surg, 1998, 65(2) :324-327.
8.	Park JS, Han WS, Kim HK, et al. Pleural abrasion for mechanical pleurodesis in surgery for primary spontaneous pneumothorax:is it effective? Surg Laparosc Endosc Percutan Tech, 2012, 22(1) :62-64.
9.	Salati M, Brunelli A, Xium F, et al. Uniportal video-assisted thoracic surgery for primary spontan eous pneumothorax:clinical and economic analysis in comparison to the traditional approach. Interact Cardiovasc Thora Surg, 2008, 7(1) :63-66.
10.	车国卫, 梅龙勇, 梅建东, 等. 单操作孔电视胸腔镜手术治疗肺部疾病158例临床分析. 中国胸心血管外科临床杂志, 2012, 19(2) :116-119.
11.	Barker A, Maratos EC, Edmonds L, et al. Recurrence rates of video-assisted thoracoscopic versus open surgery in the prevention of recurrent pneumothoraces:a systematic review of randomised and non-randomised trials. Lancet, 2007, 370(9584) :329-335.
12.	Vanderschueren RG. Pleural talcage in patients with spontaneous pneumothorax. Poumon Coeur, 1981, 37(4) :273-276.
13.	Youmans CR, Williams RD, McMinn MR, et al. Surgical manage-ment of spontaneous pneumothorax by bleb ligation and pleural dry sponge abrasion. Am J Surg, 1970, 120(5) :644-648.
14.	Kalnins I, Torda TA, Wright JS. Bilateral simultaneous pleurodesis by median sternotomy for spontaneous pneumothorax. Ann Thorac Surg, 1973, 15(2) :202-206.
15.	Cheng YJ, Chou SH, Kao EL. Video-assisted thoracoscopic suture closure of blebs to treat primary spontaneous pneumothorax. JSLS, 2004, 8(1) :35-38.
16.	Shaikhrezai K, Thompson AI, Parkin C, et al. Video-assisted thora-coscopic surgery management of spontaneous pneumothorax-long-term results. Eur J Cardiothorac Surg, 2011, 40(1) :120-123.
17.	Cardillo G, Facciolo F, Giunti R, et al. Videothoracoscopic treatment of primary spontaneous pneumothorax:a 6-year experience. Ann Thorac Surg, 2000, 69(2) :357-361.
18.	Vohra HA, Adamson L, Weeden DF. Does video-assisted thoraco-scopic pleurectomy result in better outcomes than open pleurec-tomy for primary spontaneous pneumothorax? Interact Cardiovasc Thorac Surg, 2008, 7(4) :673-677.
19.	Tsuboshima K, Nagata M, Wakahara T, et al. Relationship between postoperative bulla neogenesis at the staple line and the resected lung volume in primary spontaneous pneumothorax. Gen Thorac Cardiovasc Surg, 2015, 63(10) :572-575.
20.	Liu YH, Chao YK, Wu YC, et al. Bullae ablation in primary spon-taneous pneumothorax. World J Surg, 2009, 33(5) :938-942.
21.	Noppen M, Dekeukeleire T, Hanon S, et al. Fluorescein-enhanced autofluorescence thoracoscopy in patients with primary spontaneous pneumothorax and normal subjects. Am J Respir Crit Care Med, 2006, 174(1) :26-30.
22.	Horio H, Nomori H, Fuyuno G, et al. Limited axillary thoracotomy vs video-assisted thoracoscopic surgery for spontaneous pneumo-thorax. Surg Endosc, 1998, 12(9) :1155-1158.

1. Uramoto H, Shimokawa H, Tanaka F. What factors predict recurr-ence of a spontaneous pneumothorax? J Cardiothoracic Surg, 2012, 7(1) :1-5.
2. Santill_an-Doherty P, Argote-Greene LM, Guzman-Sanchez M. Thoracoscopic management of primary spontaneous pneumothorax. Am Surg, 2006, 72(2) :145-149.
3. Lee P. Primary spontaneous pneumothorax:to pleurodese or not? Lancet, 2013, 381(9874) :1252-1254.
4. MacDuff A, Arnold A, Harvey J. Management of spontaneous pneumothorax:British Thoracic Society Pleural Disease Guideline. Thorax, 2010, 65(suppl 2) :ii18-ii31.
5. Min X, Huang Y, Yang Y, et al. Mechanical pleurodesis does not reduce recurrence of spontaneous pneumothorax:a randomized trial. Ann Thorac Surg, 2014, 98(5) :1790-1796.
6. De Vos B, Hendriks J, Van Schil P, et al. Long-term results after video-assisted thoracic surgery for spontaneous pneumothorax. Acta Chir Belg, 2002, 102(6) :439-444.
7. Passlick B, Born C, Haussinger K, et al. Efficiency of video-assisted thoracic surgery for primary and secondary spontaneous pneumothorax. Ann Thorac Surg, 1998, 65(2) :324-327.
8. Park JS, Han WS, Kim HK, et al. Pleural abrasion for mechanical pleurodesis in surgery for primary spontaneous pneumothorax:is it effective? Surg Laparosc Endosc Percutan Tech, 2012, 22(1) :62-64.
9. Salati M, Brunelli A, Xium F, et al. Uniportal video-assisted thoracic surgery for primary spontan eous pneumothorax:clinical and economic analysis in comparison to the traditional approach. Interact Cardiovasc Thora Surg, 2008, 7(1) :63-66.
10. 车国卫, 梅龙勇, 梅建东, 等. 单操作孔电视胸腔镜手术治疗肺部疾病158例临床分析. 中国胸心血管外科临床杂志, 2012, 19(2) :116-119.
11. Barker A, Maratos EC, Edmonds L, et al. Recurrence rates of video-assisted thoracoscopic versus open surgery in the prevention of recurrent pneumothoraces:a systematic review of randomised and non-randomised trials. Lancet, 2007, 370(9584) :329-335.
12. Vanderschueren RG. Pleural talcage in patients with spontaneous pneumothorax. Poumon Coeur, 1981, 37(4) :273-276.
13. Youmans CR, Williams RD, McMinn MR, et al. Surgical manage-ment of spontaneous pneumothorax by bleb ligation and pleural dry sponge abrasion. Am J Surg, 1970, 120(5) :644-648.
14. Kalnins I, Torda TA, Wright JS. Bilateral simultaneous pleurodesis by median sternotomy for spontaneous pneumothorax. Ann Thorac Surg, 1973, 15(2) :202-206.
15. Cheng YJ, Chou SH, Kao EL. Video-assisted thoracoscopic suture closure of blebs to treat primary spontaneous pneumothorax. JSLS, 2004, 8(1) :35-38.
16. Shaikhrezai K, Thompson AI, Parkin C, et al. Video-assisted thora-coscopic surgery management of spontaneous pneumothorax-long-term results. Eur J Cardiothorac Surg, 2011, 40(1) :120-123.
17. Cardillo G, Facciolo F, Giunti R, et al. Videothoracoscopic treatment of primary spontaneous pneumothorax:a 6-year experience. Ann Thorac Surg, 2000, 69(2) :357-361.
18. Vohra HA, Adamson L, Weeden DF. Does video-assisted thoraco-scopic pleurectomy result in better outcomes than open pleurec-tomy for primary spontaneous pneumothorax? Interact Cardiovasc Thorac Surg, 2008, 7(4) :673-677.
19. Tsuboshima K, Nagata M, Wakahara T, et al. Relationship between postoperative bulla neogenesis at the staple line and the resected lung volume in primary spontaneous pneumothorax. Gen Thorac Cardiovasc Surg, 2015, 63(10) :572-575.
20. Liu YH, Chao YK, Wu YC, et al. Bullae ablation in primary spon-taneous pneumothorax. World J Surg, 2009, 33(5) :938-942.
21. Noppen M, Dekeukeleire T, Hanon S, et al. Fluorescein-enhanced autofluorescence thoracoscopy in patients with primary spontaneous pneumothorax and normal subjects. Am J Respir Crit Care Med, 2006, 174(1) :26-30.
22. Horio H, Nomori H, Fuyuno G, et al. Limited axillary thoracotomy vs video-assisted thoracoscopic surgery for spontaneous pneumo-thorax. Surg Endosc, 1998, 12(9) :1155-1158.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Efficacy and Risk Factors of Recurrence after Video-assisted Thoracoscopic Surgery for Primary Spontaneous Pneumothorax

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