Analysis Of Risk Factors For Ipsilateral Recurrence Of Primary Spontaneous Pneumothorax In Highland Areas

Objective(s):Primary spontaneous pneumothorax(PSP),defined as spontaneous chest disease that occurs in patients without underlying lung disease,is a common benign condition that affects the health of young people.Plateau area is a special environment with atmospheric physics,geochemistry,ecological structure and plain different,plateau area altitude ≥ 1500 m when human arterial blood gas index compared with plain area has obvious changes,our hospital is located in Yunnan-Guizhou Plateau(Kunming average altitude 1900+ m),PSP is one of the common emergencies of thoracic surgery.This article conducted a retrospective study of 578 patients with PSP admitted to our hospital from January 2015 to January 2022,and explored the risk factors for ipsilateral recurrence of spontaneous pneumothorax patients in plateau areas by analyzing the clinical characteristics,treatment methods and treatment outcomes of PSP patients.Methods:The case data of 578 PSP patients admitted to our hospital from January 2015 to January 2022 were retrospectively analysed by querying the hospital electronic case system.A final 294 cases were included in the study through screening,of which 86 chose conservative treatment and the remaining 208 chose surgical treatment.The clinical characteristics included: sex,age,smoking history,BMI,site of onset,history of previous pneumothorax recurrence,and type of pulmonary blister on the operated side(no or ≤2 blisters as "absent,isolated or limited",≥3 blisters or diffuse as "multiple").An altitude difference of >1500m was required to include a history of altitude migration.The study was divided into two parts,conservative and surgical,according to the treatment method.The impact of conservative versus surgical treatment on the prognosis of PSP was further investigated.Results:1.Relevance of treatment modality to PSP relapseThe results of this study found that both conservative treatment(observation,thoracentesis aspiration,closed chest drainage)and VATS had a proportionate risk of recurrence in the treatment of PSP.In this study,by univariate analysis,the recurrence rate was found to be significantly lower in the surgical group receiving VATS for PSP than in the conservative group treated with observation,thoracentesis aspiration and closed chest drainage(P<0.001).A COX multifactorial analysis concluded that conservative treatment was an independent risk factor for recurrence of PSP,and a Kaplan-Meier recurrence-free survival rate analysis showed that the recurrence-free survival rates at 1,3 and 5 years were significantly lower in the conservative group than in the surgical group,with a statistically significant difference(P<0.001).2.Risk factor analysis affecting the prognosis of conservative treatment of PSPThe conservative group was grouped according to whether there was recurrence after treatment,including 30 cases in the relapse group and 56 cases in the nonrecurrence group.The differences in gender,smoking status,and pneumothorax position between the two groups were not related to PSP recurrence,while age,body mass index(BMI),and history of altitude migration were closely related to PSP recurrence,and multivariate COX regression analysis showed that age and altitude migration history were independent risk factors for PSP recurrence.3.Analysis of risk factors affecting the prognosis of PSP in surgical treatmentThe surgical group was grouped according to whether there was recurrence after treatment,including 18 cases in the recurrence group and 190 cases in the nonrecurrence group.Univariate analysis was not associated with spontaneous pneumothorax recurrence between the two groups in length of hospital stay,history of altitude migration,size of bullae,number of bullae,location of pneumothorax,and smoking between the two groups,but BMI,age and PSP recurrence were closely related between the two groups.Multivariate COX regression analysis showed that age and BMI were independent risk factors for PSP recurrence.Conclusion(s):1.VATS bullectomy + pleurodesis at the first episode of PSP is an effective treatment for PSP because its recurrence rate is significantly lower than conservative treatment.2.Age was an independent risk factor for PSP recurrence in both conservative and surgical groups,and age was inversely correlated with recurrence rate,the younger the age of onset,the higher the recurrence rate of PSP.3.PSP due to a history of altitude migration due to a barometric pressure difference is recommended for VATS removal of bullae and mechanical pleurodesis and chemical pleurodesis can effectively reduce PSP recurrence.