Apex-to-Cupola Distance Following VATS Predicts Recurrence in Patients With Primary Spontaneous Pneumothorax

作者：Chang, Jia-Ming; Lai, Wu-Wei; Yen, Yi-Ting; Tseng, Yau-Lin; Chen, Ying-Yuan; Wu, Ming-Ho; Chen, Wei^*; Light, Richard W.

来源：Medicine, 2015, 94(37): e1509.

DOI：10.1097/MD.0000000000001509

• ASSISTED THORACOSCOPIC BULLECTOMY
• CHEST TUBE REMOVAL
• TALC POUDRAGE
• PLEURODESIS
• MANAGEMENT
• SURGERY
• LUNG
• RESECTION
• SPACE
• RISK

Our study sought to determine whether the size of the residual apical pleural space in young patients with primary spontaneous pneumothorax (PSP) following video-assisted thoracoscopic surgery is associated with the risk of recurrence.We retrospectively reviewed patients (30 years' old) with primary spontaneous pneumothorax following thoracoscopic surgery (2002-2010) in a university-affiliated hospital. The size of residual apical pleural space was estimated by measuring the apex-to-cupola distance on a postoperative chest radiograph at 2 time windows: first between postoperative day (POD) 0 and 3, and second between POD 4 and 14.A total of 149 patients were enrolled with a median follow-up of 11.2 months (interquartile range, 0.95-29.5 months), of whom 141 (94.6%) were male with a mean age of 20 years. The postoperative recurrence rate was 11.4%. Comparing the characteristics between the patients with and without recurrent pneumothorax, the patients with recurrence were younger (18.2+2.4 vs 20.7+3.7 years, P=0.008), with a lower rate of pleurodesis (35% vs1 69%, P=0.037), longer apex-to-cupola distance at POD 0 to 3 (22.4119.56 vs 10.07 +/- 10.83mm, P<0.001) and POD 4 to 14 (11.82 +/- 9.75 vs 5.54 +/- 8.38mm, P=0.005) than the patients without recurrence. In a multivariate logistic regression model for recurrent pneumothorax, age <18 years (P=0.026, odds ratio [OR]: 4.694), apex-to-cupola distance at POD 0 to 3 >10mm (P=0.027, OR: 5.319), and no pleurodesis during VATS (P=0.022, OR: 5.042) were independent risk factors for recurrent pneumothorax.The recurrence rate was not low (11.4%) in young patients with PSP following VATS. Residual apical pleural space with apex-to-cupola distance of 10mm or greater at POD 0 to 3, younger age, and no pleurodesis would increase postoperative recurrence of primary spontaneous pneumothorax.

• 出版日期2015-9
• 单位中国医科大学