Trentment Of Spontaneous Pneumothorax By Medical Thoracoscopic Talcage

Objective:Pneumotharox is a commom respiratory disease and spontaneous pneumothorax is more usual.According to whether the primary lung disease exist,SP usually can be divided into primary and secondary spontaneous pneumothorax. Pneumothorax hazards patients'health, affects their life quality, and is also a heavy burden to society. Therefore, the proper treatment of pneumothorax is a serious problem.Curative surgical treatment has an exact effect:the recurrence rate is lowest, but the trauma of the surgeries and high costs, make suigery impossible to many patients.Pleurodesis is a curative method that physical,chemical or biotical irritats are induced into the pleural cavity where these irritats produce sterile inflammation which make adhesion between vesical and parietal pleura. Since 1935, Bethune use iodized talc for the first time to induce pleurodesis successfully,today there are noumorous agents for pleurodesis:physical and chemical agents (ex.mechanical friction, hypertonic glucose, talc,tetracycline,silver nitrate),bioticalagents(ex.BCG,Corynebacterium),cytokines(ex.TGF-b2),autologous blood,fibrinogen, thrombin and so on.Among these,talc is the most commonly used agent,which is effctive,safe,affordable and recognised by by many scholars.Pleurodesis agent can be injected by the thoracic chest tube or thoracoscopy law. The former requires full lung recruitment, thoracic drainage less than 200ml/d, and patients should regularly convert position to make the suspension evenly distributed to the pleural surface.The later has more advantages:the operator can release adhesions in the microscope, and talc can be more smoothly into the chest; spray talc under direct vision to ensure that the pleural covered uniformly, to complete occlusion of the pleural cavity. Moreover, compared to chest tube, thoracoscopy dose not cause more damage. and to thoracoscopic surgery, requries low-cost, no anesthesia, rapid recovery, which make it more acceptabile to patients.The purpose of this article is to abserve curative value of midical thotascopic talcage for SP and its side effects.Methods:Objects:Fifty-five SP patients are cellected from Shandong provincial hospital bitween 1996-2009, which accepte midical thotascopic talcag,and most are refracory or continued SP.Instument:rigid-thoracoscopy of olpmpus, trachor,aspirator,duster,biospy forcep,monitor, cold light source,mushroom drainegre tube.Preparation:All patients accept the preoperative examination:the clotting time, ECG, chest X-ray to avaluate pleural adhesions; 15 minutes to half an hour bofore tretment intramuscular injection of of 10 mg diazepam, if necessary an injection of pethidine; low-flow oxygen, continuous monitoring of oxygen saturation and heart rate.Steps:Patients atre lying contralateral,exposure the affected side of pleural cavity sufficiently,take 4th at anterior axilarry line or 5th at the middle axilarry line or 6th at the posterior axilarry line intercostal space as the incision, insterile skin,anesthesin from skin to parietal pleural.Then make an incision parellel to intercostal space,dissociate suncutanous tissue to pleural cavity,exan the pleural cavity especially the positon,numbe,rand size bullae,look for the leak;release adhesion after ensure of abbesnce of big vessles;break the bullae and then spray 3-5g talc uniformly under microscopy.Before the spray,injec 50mg pethedine intramuscularly. Leave a mushroom drainage tube,encourage the patient to cough to discharge air. Extubation is after more than 24 hours unleakage and drainage of pleural fluid less than 50 ml/d, before extubation take a chest radiograph to view lung recruitment.In the period of hospital no need of further surgery to the affected side for lung reexpansion completely is seen as successful.All the statistical analyses were carried out using SPSS17.0, the significance of different groups were evaluated by means ofχ2 test or the exact Fisher's test. Numeric variable data is tested T tes and P<0.05 was considered statistically significant t. Results:1 case need further surgical treatment; the remaining 50 patients were cured, the cure rate is98.04%. The average extubation time of cured 50 patients is day. There are no acute respiratory failure, reexpansion pulmonary edema,or other serious complications; fever, chest pain are common..Body temperature is mostly below 39℃, and after anti-inflammatory treatment and symptomatic treatment usually return to normal within 2-5 day. Chest pain is non-violent, relieved by intramuscularly injetion of pethidine.Conclusions:Medical thoracoscopic talc pleurodesis is an effective method of treatment of primary pneumothorax, with high cure rate, few adverse reactions and serious complications.