| 摘要 |
Objective: Primary spontaneous pneumothorax has been recognized for a long time as a common cause of hospitalization in young people with significant socioeconomic impact. Rupture of the apical subpleural blebs is the mechanism responsible for most primary spontaneous pneumothorax. The objectives of treatment are to obtain full re-expansion of the affected lung, to control the complication and to prevent recurrence. Blebectomy and pleural abrasion has been suggested for definitive treatment of recurrent primary spontaneous pneumothorax. Traditionally, the blebectomy and pleural abrasion was carried out through a posterolateral thoracotomy approach and had the problem of postoperative grave wound pain and longer hospitalization. Recently, the VATS has the benefit of less wound pain and ahorter hospitalization but higher recurrence rate and cost. This study is a review of our experience with blebectomy and pleural abrasion through an axillary mini-incision and its long-term efficiency in preventing recurrence of the disease.
Mthods: Between 1995 and 2001, 209 transaxillary blebectomy and pleural abrasion were carried out for definitive treatment of primary spontaneous pneumothorax in 185 patients. Surgical indications included recurrence, bilaterality of the disease, persisted air leakage, hemopneumothorax, and present bleb or bulla in high resolution CT scan of lung. During transaxillary blebectomy and pleural abrasion, the patients were placed in a lateral position under single lumen endotracheal intubated anesthesia.
Results: The average operative time was 60 minutes. There was no operative death but one wound hematoma and one patient required re-exploration for blood clot removal. The average postoperative period of hospitalization was 6 days. One hundred and eighty-five patients were followed-up one to six years after operation. There were three documented episodes of recueeent ipsilateral pneumothorax(1.4%). In postoperative physical activity, there were no significant abnormalities compared with preoperative physical activity. The cosmetic effect was satisfied and wound pain minimal in most patients.
Comclusion: Transaxillary is a simple acceptable surgical approach for treatment of primary spontaneous pneumothorax. |
