Clinical Evaluation of Open Thoracotomy Cases in Spontaneous Pneumothorax

Lee, Yuen Je; Hwang, Sang Won; Kim, Han Yong; Song, Won Young; Yoo, Byung Ha

Abstract

Spontaneous pneumothorax is the sudden collapse of a lung usually caused by air leakage from a subvisceral pleural bleb. Responses to closed thoracostomy,thoracentesis and simple observation are usually prompt and effective. But in some cases, these are unsucceful and open thoracotomy is indicated. A clinical evaluation was performed on 242 cases(236 patients) of open thoracotomy in spontaneous pneumothorax who were admitted and treated at department of Thoracic and Cardiovascular Surgery. Masan Samsung General Hospital during the past 9 years from January 1988 to December 1996. The results were as follows 1. The sex ratio was male predominance(M:F=11.7:1). 2. The most common age group were 2nd, 3rd decades(2nd=29.3%, 3rd=30.2%). 3. The most common chief complaints were chest pain and dyspnea(chest pain=41.7%, dyspnea=36.8). 4. The etiologic factors of spontaneous pneumothorax were primary spontaneous pneumothorax(86.4%), tuberculosis(9.1%), COPD(3.7%) and pleuritis(0.8%). 5. The site of spontaneous pneumothorax was 52.1% in right, 45.4% in left and 2.5% in both. 6. The common indications of open thoracotomy were recurrence(44.2%), persistent air leakage(31.8%) and inadequate expansion(15.7%). 7. The operative procedures were bullectomy or mechanical pleurodesis through posterolateral thoracotomy or median sternotomy. 8. The most frequent location of bulla or bleb were apical segment of RUL(35.1%) and apicoposterior segment of LUL(41.3%). 9. The number of bulla or bleb were mainly 1 to 5(88%), and there were no significant differences among operation indications. 10. The size of bulla or bleb were mainly below 5cm(81%)and small bulla(5cm)were predominant in persistent air leakage and inadequate expansion group. 11. The pleural adhesion was seen in 54.5%.(Recurrence group 64.1%, Persistent air leakage group 51.9%,Inadequate expansion group 47.4%).