Simultaneous And Staged Surgical Treatment Of Bilateral Pulmonary Bullae In Patients With Bilateral Spontaneous Pneumothorax

Objective: Bilateral bullobectomy at the same time was superior to bilateral bullobectomy by stages in comparison of complications such as air leak,infection and recurrence rate of bullae,the operation time,extubation time,hospitalization days,incision length and hospitalization expenses were compared.The advantages and disadvantages of simultaneous and staged operation were studied.Methods: According to inclusion exclusion criteria,the clinical data of two-stage bilateral bullobectomy were collected from January 2015 to December 2020 in the Department of Thoracic Surgery of the Zunyi Medical University Hospital and from January 2015 to February 2020 in the Department of Thoracic Surgery of the Zunyi Medical University Hospital.The experimental group was treated with bilateral bulla resection at the same time,and the control group was treated with bilateral bulla resection by stages.A cohort study was conducted in both groups.There were 40 cases in the experimental group and 18 cases in the control group.The differences of postoperative complications such as pulmonary leak,infection and recurrence rate of bullae were compared between the two groups,the time of Operation,time with Tube,length of stay,amount of bleeding during operation,amount of drainage 24 hours after operation,hospital expenses and number of nail bins were compared.To evaluate the advantages and disadvantages of bilateral bullae resection in the same period compared with bilateral bullae resection by stages,and to identify the optimal operation.Results: A total of 40 patients underwent bilateral bullobectomy and pleurodesis from January 2015 to December 2020,and 18 patients underwent bilateral bullobectomy and pleurodesis from January 2015 to December 2020.A total of 58 patients were included in the study,including 40 in the experimental group and 18 in the control group.The mean age was 20.50 ± 8.08 years in the experimental group and 18.00 ± 10.33 years in the control group.There was no significant difference in sex and age between the two groups(P > 0.05).The amount of intraoperative bleeding was 20.00(20.00,50.00)ML in the experimental group and 40.00(28.75,62.50)ML in the control group,the difference was statistically significant(P< 0.05),there was no significant difference between the two groups(P> 0.05),the operation time of the experimental group was 123.00 ± 41.56 Min,the operation time of the Control Group was 125.00 ± 34.65 Min,the difference was not statistically significant(P> 0.05),the hospitalization time of the experimental group was9.50 ± 4.09 days,and that of the control group was 14.50 ± 5.20 days,the difference was statistically significant(P< 0.05),the hospitalization expenses of the experimental group was 42.638 ± 1.649 yuan,the cost of hospitalization in control group was 58023 ± 10921 yuan,the difference was statistically significant P< 0.05),the time of tube-carrying in experimental group was 5.00 ± 2.38 days,the time of tube-carrying in control group was9.00 ± 3.55 days,the difference was statistically significant(P< 0.05),the drainage volume was 392.50 ± 317.39 ml in the experimental group 24 hours after operation,and750 ± 228.64 ML in the control group,the difference was statistically significant(P<0.05);The postoperative hospitalization time of the experimental group was 8.05 ± 3.95 days,and that of the control group was 13.00 ± 4.15 days.The difference was statistically significant(P< 0.05)In the experimental group,there were 5 cases of persistent air leak,1case of severe pneumonia,1 case of incision infection,2 cases of persistent air leak,1 case of incision infection and 1 case of enveloped hydropneumothorax,there was no significant difference between the experimental group and the Control Group in the incidence of complications.There was no recurrence in the control group half a year after operation.There was no significant difference in the complications between the experimental group and the Control Group.Conclusion: In patients with bilateral spontaneous pneumthorax,bilateral bullobectomy and pleural fixation were performed simultaneously,although they did not save the operation time and the number of staples,however,it has obvious advantages in hospitalization time,hospitalization expenses,drainage volume at 24 hours after operation,time with tube after operation and hospitalization time after operation.