Clinical Analysis of the Surgical Treatments for Large Primary Spontaneous Pneumothorax

Kim, Byung Ho; Huh, Dong Myung; Han, Won Kyung

Abstract

BACKGROUND: The clinical history and physical findings of the patients with spontaneous pneumothorax depend largely on the extent of the collapse of the lung and the presence of pre-existing pulmonary disease. Large primary spontaneous pneumothorax is a possible serious condition and so more active treatment will be necessary for these patients. The therapeutic guideline for large pneumothorax remains controversial. Therefore, by assessing the clinical results of surgical treatment for large primary pneumothorax, we aim to determine the indicators of treatment. MATERIAL AND METHOD: Among 348 patients with primary spontaneous pneumothorax and who underwent surgical treatment from August 2004 through December 2007, 58 patients who responded to treatment for a large primary pneumothorax were included in the current study. We then retrospectively evaluated the operative findings and the surgical results. The patients with a pneumothorax of 80% or more, including those patients with tension pneumothorax, were considered to have a "large pneumothorax". Most of these patients should be treated with a 12F chest tube. Thoracoscopic wedge resection was considered for treating recurrent pneumothorax, continuous air leakage, controlateral pneumothorax and first episode pneumothorax with visible blebs (> 1 cm) seen on the computed tomography. RESULT: There were 50 men and 8 women with a mean age of 28.2 years (range: 14~54 years). The mean length of hospitalization was 5.3 days (range: 2~10 days). Nine patients underwent chest tube drainage only. Forty-nine patients underwent thoracoscopic wedge resection. The mean follow up time was 27.8 months (range: 10~58 months). The actual site of air leakage could be located in 35 patients (71.4%) and this was correlated with pleural adhesion (p=0.005). The initial air leakage tended to be more correlated with intraoperative air leakage, although this was not statistically significant (p=0.066). The recurrence rate was 11.1% for the patients with chest tube drainage and 2.0% for the patients with thoracoscopic wedge resection.
CONCLUSION
Large primary pneumothorax requires an early diagnosis and early treatment. Thoracoscopic wedge resection may help to prevent recurrence of large primary pneumothorax.