Treatment plan and clinical effect of the first primary spontaneous pneumothorax in young patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Xiaolong ¹ , WEI Haitao ¹ , ZHANG Haifeng ¹ , ZHANG Feng ¹ , HU Baoli ¹ , ZHANG Donghong ¹ , DING Kai ¹ , HOU Tao ¹ ,  CHE Guowei ²

1. Department of Thoracic Surgery, Huaihe Hospital of Henan University, Kaifeng, 475000, Henan, P.R.China;
2. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

CHE Guowei, Email: guowei_che@yahoo.com

Keywords：

Primary spontaneous pneumothorax; non-surgical treatment; surgical treatment; recurrence

DOI：

10.7507/1007-4848.202006045

Video：

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Objective To investigate the optimal treatment scheme for the first primary spontaneous pneumothorax (PSP) in young patients.Methods The clinical data of 171 patients with the first PSP were retrospectively analyzed who were treated in Huaihe Hospital of Henan University between November 2011 and October 2017. There were 157 males and 14 females with a median age of 18 years at onset and a median body mass index of 18.51 kg/m². According to the treatment methods, they were classified into two groups, a conservative treatment group (a non-surgical group, n=86) and a surgical group (n=85). The characteristics including clinical data, efficacy evaluation criteria, complications and recurrence of the two groups were analyzed.Results As a result, 73.68% of the patients suffered PSP in their daily routine. The drainage duration in the non-surgical group was longer than that in the surgical group (4 d vs. 3 d, P=0.008). There was no statistical difference in the success rate of lung re-expansion between the two groups (98.85% vs. 100.00%, P=1.000). The proportion of the surgical group using postoperative analgesic drugs was higher than that in the non-surgical group (48.23% vs. 10.46%, P=0.000). The recurrence rate of the surgical group was lower than that of the non-surgical group (3.53% vs. 46.51%, P=0.000). No relationship between smoking and recurrence of pneumothorax was found in both groups (P=0.301, P=1.000). The success rate of lung re-expansion in the non-surgical group was not statistically different between the 24F subgroup and the 12F subgroup (39/39 vs. 33/34, P=0.458). No advantage of intraoperative pleural fixation was found in the surgical group (P=0.693).Conclusion Thoracoscopic surgery is the first choice for the treatment of the first PSP in young patients.

Citation： WANG Xiaolong, WEI Haitao, ZHANG Haifeng, ZHANG Feng, HU Baoli, ZHANG Donghong, DING Kai, HOU Tao, CHE Guowei. Treatment plan and clinical effect of the first primary spontaneous pneumothorax in young patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(8): 979-983. doi: 10.7507/1007-4848.202006045 Copy

1.	Laënnec RTH. De l'auscultation mediate, ou traité du diagnostic des maladies des poumons et du coeur, fondé principalement sur ce nouveau moyen d'exploration. Paris: Brosson and Chaudé, 1819.
2.	MacDuff A, Arnold A, Harvey J, et al. Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010. Thorax, 2010, 65(Suppl 2): ii18-ii31.
3.	Tschopp JM, Bintcliffe O, Astoul P, et al. ERS task force statement: Diagnosis and treatment of primary spontaneous pneumothorax. Eur Respir J, 2015, 46(2): 321-335.
4.	Chen JS, Chan WK, Tsai KT, et al. Simple aspiration and drainage and intrapleural minocycline pleurodesis versus simple aspiration and drainage for the initial treatment of primary spontaneous pneumothorax: An open-label, parallel-group, prospective, randomised, controlled trial. Lancet, 2013, 381(9874): 1277-1282.
5.	Massongo M, Leroy S, Scherpereel A, et al. Outpatient management of primary spontaneous pneumothorax: A prospective study. Eur Respir J, 2014, 43(2): 582-590.
6.	Bense L, Lewander R, Eklund G, et al. Nonsmoking, non-alpha 1-antitrypsin deficiency-induced emphysema in nonsmokers with healed spontaneous pneumothorax, identified by computed tomography of the lungs. Chest, 1993, 103(2): 433-438.
7.	Baumann MH, Strange C, Heffner JE, et al. Management of spontaneous pneumothorax: An American College of Chest Physicians Delphi consensus statement. Chest, 2001, 119(2): 590-602.
8.	Harvey J, Prescott RJ. Simple aspiration versus intercostal tube drainage for spontaneous pneumothorax in patients with normal lungs. British Thoracic Society Research Committee. BMJ, 1994, 309(6965): 1338-1339.
9.	Andrivet P, Djedaini K, Teboul JL, et al. Spontaneous pneumothorax. Comparison of thoracic drainage vs immediate or delayed needle aspiration. Chest, 1995, 108(2): 335-339.
10.	Noppen M, Alexander P, Driesen P, et al. Manual aspiration versus chest tube drainage in first episodes of primary spontaneous pneumothorax: A multicenter, prospective, randomized pilot study. Am J Respir Crit Care Med, 2002, 165(9): 1240-1244.
11.	Ayed AK, Chandrasekaran C, Sukumar M. Aspiration versus tube drainage in primary spontaneous pneumothorax: A randomised study. Eur Respir J, 2006, 27(3): 477-482.
12.	Parlak M, Uil SM, van den Berg JW. A prospective, randomised trial of pneumothorax therapy: Manual aspiration versus conventional chest tube drainage. Respir Med, 2012, 106(11): 1600-1605.
13.	王晓龙, 韩婉青, 张锋, 等. 猪尾巴导管行胸腔闭式引流术在青少年首次自发性气胸中的临床应用. 中华胸心血管外科杂志, 2018, 34(10): 617-619.
14.	Herrmann D, Klapdor B, Ewig S, et al. Initial management of primary spontaneous pneumothorax with video-assisted thoracoscopic surgery: A 10-year experience. Eur J Cardiothorac Surg, 2016, 49(3): 854-859.
15.	Sedrakyan A, van der Meulen J, Lewsey J, et al. Video assisted thoracic surgery for treatment of pneumothorax and lung resections: Systematic review of randomised clinical trials. BMJ, 2004, 329(7473): 1008.
16.	乔贵宾, 陈刚. 自发性气胸的处理: 广东胸外科行业共识(2016 年版). 中国胸心血管外科临床杂志, 2017, 24(1): 6-15.
17.	郑中龙. 胸腔镜肺大疱切除并胸膜摩擦术治疗气胸疗效的Meta分析. 大家健康(下旬版), 2017, 11(7): 8-9.
18.	杨梅, 樊骏, 周红霞, 等. 胸腔镜肺癌肺叶切除术后16 F较28 F胸腔引流管应用的临床优势. 中国肺癌杂志, 2015, 18(8): 512-517.
19.	王晓龙, 侯涛, 张锋, 等. 青少年自发性气胸经胸腔镜肺大疱切除术后两种胸腔引流管的应用分析. 河南大学学报(医学版), 2020, 39(1): 23-26.
20.	Bense L, Eklund G, Wiman LG. Smoking and the increased risk of contracting spontaneous pneumothorax. Chest, 1987, 92(6): 1009-1012.
21.	Beshay M, Kaiser H, Niedhart D, et al. Emphysema and secondary pneumothorax in young adults smoking cannabis. Eur J Cardiothorac Surg, 2007, 32(6): 834-838.

1. Laënnec RTH. De l'auscultation mediate, ou traité du diagnostic des maladies des poumons et du coeur, fondé principalement sur ce nouveau moyen d'exploration. Paris: Brosson and Chaudé, 1819.
2. MacDuff A, Arnold A, Harvey J, et al. Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010. Thorax, 2010, 65(Suppl 2): ii18-ii31.
3. Tschopp JM, Bintcliffe O, Astoul P, et al. ERS task force statement: Diagnosis and treatment of primary spontaneous pneumothorax. Eur Respir J, 2015, 46(2): 321-335.
4. Chen JS, Chan WK, Tsai KT, et al. Simple aspiration and drainage and intrapleural minocycline pleurodesis versus simple aspiration and drainage for the initial treatment of primary spontaneous pneumothorax: An open-label, parallel-group, prospective, randomised, controlled trial. Lancet, 2013, 381(9874): 1277-1282.
5. Massongo M, Leroy S, Scherpereel A, et al. Outpatient management of primary spontaneous pneumothorax: A prospective study. Eur Respir J, 2014, 43(2): 582-590.
6. Bense L, Lewander R, Eklund G, et al. Nonsmoking, non-alpha 1-antitrypsin deficiency-induced emphysema in nonsmokers with healed spontaneous pneumothorax, identified by computed tomography of the lungs. Chest, 1993, 103(2): 433-438.
7. Baumann MH, Strange C, Heffner JE, et al. Management of spontaneous pneumothorax: An American College of Chest Physicians Delphi consensus statement. Chest, 2001, 119(2): 590-602.
8. Harvey J, Prescott RJ. Simple aspiration versus intercostal tube drainage for spontaneous pneumothorax in patients with normal lungs. British Thoracic Society Research Committee. BMJ, 1994, 309(6965): 1338-1339.
9. Andrivet P, Djedaini K, Teboul JL, et al. Spontaneous pneumothorax. Comparison of thoracic drainage vs immediate or delayed needle aspiration. Chest, 1995, 108(2): 335-339.
10. Noppen M, Alexander P, Driesen P, et al. Manual aspiration versus chest tube drainage in first episodes of primary spontaneous pneumothorax: A multicenter, prospective, randomized pilot study. Am J Respir Crit Care Med, 2002, 165(9): 1240-1244.
11. Ayed AK, Chandrasekaran C, Sukumar M. Aspiration versus tube drainage in primary spontaneous pneumothorax: A randomised study. Eur Respir J, 2006, 27(3): 477-482.
12. Parlak M, Uil SM, van den Berg JW. A prospective, randomised trial of pneumothorax therapy: Manual aspiration versus conventional chest tube drainage. Respir Med, 2012, 106(11): 1600-1605.
13. 王晓龙, 韩婉青, 张锋, 等. 猪尾巴导管行胸腔闭式引流术在青少年首次自发性气胸中的临床应用. 中华胸心血管外科杂志, 2018, 34(10): 617-619.
14. Herrmann D, Klapdor B, Ewig S, et al. Initial management of primary spontaneous pneumothorax with video-assisted thoracoscopic surgery: A 10-year experience. Eur J Cardiothorac Surg, 2016, 49(3): 854-859.
15. Sedrakyan A, van der Meulen J, Lewsey J, et al. Video assisted thoracic surgery for treatment of pneumothorax and lung resections: Systematic review of randomised clinical trials. BMJ, 2004, 329(7473): 1008.
16. 乔贵宾, 陈刚. 自发性气胸的处理: 广东胸外科行业共识(2016 年版). 中国胸心血管外科临床杂志, 2017, 24(1): 6-15.
17. 郑中龙. 胸腔镜肺大疱切除并胸膜摩擦术治疗气胸疗效的Meta分析. 大家健康(下旬版), 2017, 11(7): 8-9.
18. 杨梅, 樊骏, 周红霞, 等. 胸腔镜肺癌肺叶切除术后16 F较28 F胸腔引流管应用的临床优势. 中国肺癌杂志, 2015, 18(8): 512-517.
19. 王晓龙, 侯涛, 张锋, 等. 青少年自发性气胸经胸腔镜肺大疱切除术后两种胸腔引流管的应用分析. 河南大学学报(医学版), 2020, 39(1): 23-26.
20. Bense L, Eklund G, Wiman LG. Smoking and the increased risk of contracting spontaneous pneumothorax. Chest, 1987, 92(6): 1009-1012.
21. Beshay M, Kaiser H, Niedhart D, et al. Emphysema and secondary pneumothorax in young adults smoking cannabis. Eur J Cardiothorac Surg, 2007, 32(6): 834-838.

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Treatment plan and clinical effect of the first primary spontaneous pneumothorax in young patients

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