Clinical Analysis Of Related Factors Of Recurrence After Primary Spontaneous Pneumothorax Operation

Background and Objective:Primary spontaneous pneumothorax is a common emergency disease defined as the accumulation of air in the pleural space with secondary lung collapse. PSP occurs most commonly in young, tall, thin males with no predisposing lung disease or history of thoracic trauma and the incidence is believed to be increasing in recent years. It is about one hundred and eighty years of the treatment for primary spontaneous pneumothorax. Treatment options vary greatly from observation to operation. medical conservative treatments, including simple observation, aspiration, and tube thoracostomy and chemical pleurodesis;and surgical treatments, including traditional thoractomy, subaxillary minithoractomy, video-assisted thoracoscopy, and (or) pleurodesis. The main purpose of treatment is to make the collapse lung tissue reexpansion quickly and completely restore lung function and prevent of recurrence. Tube thoracostomy or aspiration was once usually the first-line treatment for primary spontaneous pneumothorax. However, it is also known that approximately 30% of patients who receive conservative therapy will have a recurrence.And with the number of relapse increase , the possibility of recurrence of pneumothorax will increase. Recurrent rate of ipsilateral pneumothorax after the first episode occurs in 25% , the second rate> 50%,and the third rate more than 80%. Surgical resection of lung bullae and pleurodesis is the only effective treatment or recurrent spontaneous pneumothorax, The postoperative recurrence rate decrease to 1- 3%, but it is more invasive.Before video-assisted thoracoscopic surgery (VATS) was initiated, open thoractomy, transaxillary thoractomy, was performed as a surgical procedure. However, increasing patient discomfort results in restricted application of open thoractomy in a patient with a recurrence or prolonged air leakage. In 1990, the first VATS was reported by Levi et al. Since then, this technique has spread rapidly and VATS has taken over the role of open thoractomy, due to its minimal invasiveness and low morbidity. In China , along with the socio-economic development ,the problem of expensive equipment to video-assisted thoracoscopy gradually is being solved. Thoracic-assisted minimally surgery has been well acceptable to patients and surgeons, and surgical treatment of primary spontaneous pneumothorax has become mainstream. However, there are still some issues remaining regarding the recurrence rate and the timing of the VATS. There are several causes for the post-operative recurrent pneumothorax:Omitting pulmonary bullae during the exploration, handling bulla inproperly , Neonatal lung bullae and no pleurodesis. The relevant factors of post-operation recurrent pneumothorax can be classified as two aspects: one factors related to patient such as age, height, body mass index, gender, number of episode preoperation, positions; the other factors related to surgery, such as surgical procedures, surgical methods.pleurodesis and postoperative drainage time. At present, although rupture of an underlying small subpleural bleb or bulla is thought to be responsible in many cases, Moreover, current cigarette smoking greatly increases the risk of developing a pneumothorax by as much as nine times,But the exact cause is uncertain. It is suggested pneumothorax may be related to thiner and taller body and the genetic quality. Surgery can not change either one of the two, so new bullae may occur after the operation, The rupture of new bulla may result in recurrent pneumothorax.It was reported that the surgery procedure related to post-operative recurrent pneumothorax .Most of all is Omitting pulmonary bullae, of which post-operative pneumothorax occur in earlier time. It is considered not carefully explore hidden sites, such as the mediastinal surface of lung, or interlobar fissure and so on. Then it is that improper treatment of rupture of large bubbles may cause recurrent episode of pneumothorax. In addition ,the way of treatment of bullous lung also can affect the recurrence of lung bullae ligation significantly more than those who relapse after resection of bullous.Methods:This research is to analyze the relative factors affected the recurrence of primary spontaneous pneumothorax after operation, and discuss the possible methods to improve the effect of operation. Methods: The clinical data of 325 cases with primary spontaneous pneumothorax were collected, Which had undergone thoracic operation at Jilin University First Hospital Department of Thoracic Surgery from 2000/1 to 2007/12.The age at the time of operation,sex, height, body mass index(BMI), position of episode, number of episode, VATS/minithoracotomy,type ,pleurodesis and time of drainage were recorded, and the postoperative recurrence rate was calculated.Univariate and multivariate analysis were performed for possible factors related to recurrence.Results:The overall recurrence rate was 4.3%.The number of episode, the height of male ,BMI ,type and pleurodesis were related factors of recurrence (P<0.05).The sex,height of female, age of episode, position of episode and time of drainage were not related to the rate of recurrence.Conclusions:1.The relations between the recurrecneand sex,age,height of female, position of episode and time of drainage were not statistically obvious.2.The number of episode,MBI and pleurodesis are the predictive factors of recurrence after operation.3.We consider video-assisted thoracoscopy with pulmonary bubller resection and pleural abrasion as an effective way to resolve the pneumothorax and prevent recurrence ,as good as traditional thoractomy and subaxillary Mimi-thoractomy.